title: Increasing hospital charges for adolescent idiopathic scoliosis in the United States.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To determine the trends and causes for increases in hospital charges in adolescent idiopathic scoliosis (AIS) fusions.
  
  
  BACKGROUND
  Trends in utilization rates, surgical procedure types, and hospital charges for AIS fusions have not been well investigated.
  
  
  METHODS
  We used International Classification of Diseases, Ninth Revision, billing codes to identify 29,594 AIS fusion cases from the National Inpatient Service (NIS) database between 2001 and 2011. Data were trended over time, and contrasted against other common procedures. To identify specific drivers of charges, we queried our own hospital's billing system, and averaged charges from 40 cases (10 cases for each of 4 yr studied). Dollar amounts were adjusted for inflation to 2011 dollars.
  
  
  RESULTS
  Utilization rates for AIS fusions have remained constant, whereas utilization of adult spinal fusions increased by 64% (P = 0.0004). Utilization of anterior thoracic fusions decreased by 80% (P < 0.0001). Mean hospital charges for AIS spinal fusions increased from $72,780 in 2001 to $155,278 in 2011 (113% increase), averaging 11.3% annually (P < 0.0001), with charges for adult spinal procedures increasing at a similar rate (13.4% annually, P < 0.0001). Charges for the other nonspine conditions increased to a lesser degree (range of 4.5%-6% annually, P < 0.001 for each). At our institution, spinal implant charges increased 27.6% annually, whereas surgeon charges decreased 0.5% annually, and all other charges increased only 5.2% annually. Over time, our surgeon used greater numbers of pedicle screws, and greater numbers of implants per surgery and per level fused (P < 0.05 for each). Implant charges were 28% of the total hospital bill in 2003, rising to 53% in 2012.
  
  
  CONCLUSIONS
  Although utilization rates for AIS fusions have remained constant over time, hospital charges have increased substantively, and there has been a shift toward performing posterior only surgical procedures. This corresponds to the widespread adoption of pedicle screw-based constructs. Spinal implants may be the primary driver of increased charges. Strategies directed toward implant cost savings may thus have the largest impact.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Mendoza-Lattes
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Ilgenfritz
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Weinstein
mesh_terms: D000293:Adolescent; D001863:Bone Screws / Q000191:economics; D015331:Cohort Studies; D005260:Female; D017722:Hospital Charges / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000191:economics* / Q000601:surgery; D013123:Spinal Fusion / Q000191:economics* / Q000706:statistics & numerical data; D013525:Surgical Instruments / Q000191:economics; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome; D014481:United States