title: Cost analysis of incidental durotomy in spine surgery.
abstract: METHODS
  Retrospective database analysis.
  
  
  OBJECTIVE
  To characterize the consequences of an incidental durotomy with regard to perioperative complications and total hospital costs.
  
  
  BACKGROUND
  There is a paucity of data regarding how an incidental durotomy and its associated complications may relate to total hospital costs.
  
  
  METHODS
  The Nationwide Inpatient Sample database was queried from 2008 to 2011. Patients who underwent cervical or lumbar decompression and/or fusion procedures were identified, stratified by approach, and separated into cohorts based on a documented intraoperative incidental durotomy. Patient demographics, comorbidities (Charlson Comorbidity Index), length of hospital stay, perioperative outcomes, and costs were assessed. Analysis of covariance and multivariate linear regression were used to assess the adjusted mean costs of hospitalization as a function of durotomy.
  
  
  RESULTS
  The incidental durotomy rate in cervical and lumbar spine surgery is 0.4% and 2.9%, respectively. Patients with an incidental durotomy incurred a longer hospitalization and a greater incidence of perioperative complications including hematoma and neurological injury (P < 0.001). Regression analysis demonstrated that a cervical durotomy and its postoperative sequelae contributed an additional adjusted $7638 (95% confidence interval, 6489-8787; P < 0.001) to the total hospital costs. Similarly, lumbar durotomy contributed an additional adjusted $2412 (95% confidence interval, 1920-2902; P < 0.001) to the total hospital costs. The approach-specific procedural groups demonstrated similar discrepancies in the mean total hospital costs as a function of durotomy.
  
  
  CONCLUSIONS
  This analysis of the Nationwide Inpatient Sample database demonstrates that incidental durotomies increase hospital resource utilization and costs. In addition, it seems that a cervical durotomy and its associated complications carry a greater financial burden than a lumbar durotomy. Further studies are warranted to investigate the long-term financial implications of incidental durotomies in spine surgery and to reduce the costs associated with this complication.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Sreeharsha V
authors.initials: SV
authors.lastname: Nandyala
authors.forename: Islam M
authors.initials: IM
authors.lastname: Elboghdady
authors.forename: Alejandro
authors.initials: A
authors.lastname: Marquez-Lara
authors.forename: Mohamed N B
authors.initials: MN
authors.lastname: Noureldin
authors.forename: Sriram
authors.initials: S
authors.lastname: Sankaranarayanan
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D019299:Decompression, Surgical / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000191:economics*; D016896:Treatment Outcome