title: Delayed cervical palsy following cervical spine fusion leads to an increase in hospital-related costs.
abstract: OBJECTIVE
  Delayed cervical palsy (DCP) is a known complication following cervical spine surgery. While most DCPs eventually improve, they can result in significant temporary disability. Postoperative complications affect hospital length of stay (LOS) as well as overall hospital cost. The authors sought to determine the hospital cost of DCP after cervical spine fusion operations.
  
  
  METHODS
  A retrospective review of patients undergoing cervical fusion for degenerative disease at the Mayo Clinic from 2008 to 2012 was performed. Patients who developed DCPs not attributable to intraoperative trauma were included. All nonoperative-related costs were compared with similar costs in a control group matched according to age, sex, and surgical approach. All costs and services were reflective of the standard costs for the current year. Raw cost data were presented using ratios due to institutional policy against publishing cost data.
  
  
  RESULTS
  There were 27 patients (18 men, 9 women) who underwent fusion and developed a DCP over the study period. These patients were compared with 24 controls (15 men, 9 women) undergoing fusion in the same time period. There was no difference between patients and controls in mean age (62.4 ± 3.1 years vs. 63.8 ± 2.5 years, respectively; p = 0.74), LOS (4.2 ± 3.3 days vs 3.8 ± 4.5 days, respectively; p = 0.43), or operating room-related costs (1.08 ± 0.09 vs. 1.0 ± 0.07, respectively; p = 0.58). There was a significant difference in nonoperative hospital-related costs between patients and controls (1.67 ± 0.15 vs 1.0 ± 0.09, respectively; p = 0.04). There was a significantly higher utilization of postoperative imaging (CT or MRI) in the DCP group (14/27, 52%) when compared with the matched cohort (4/24, 17%; p = 0.018), and a significantly higher utilization of physiatry services (24/27 [89%] vs 15/24 [63%], respectively; p = 0.046).
  
  
  CONCLUSIONS
  While DCPs did not significantly prolong the length of hospitalization, they did increase hospital-related costs. This method could be further extrapolated to model costs of other complications as well.
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and.
authors.forename: Ross C
authors.initials: RC
authors.lastname: Puffer
authors.forename: William E
authors.initials: WE
authors.lastname: Clifton
authors.forename: Grant W
authors.initials: GW
authors.lastname: Mallory
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Clarke
mesh_terms: D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000191:economics; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000191:economics / Q000209:etiology*; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D011843:Radiculopathy / Q000191:economics / Q000209:etiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000601:surgery
keywords: DCP = delayed cervical palsy; LOS = length of stay; OR = operating room; control; delayed cervical palsy; fusion; hospital costs; length of stay; operating room costs; physiatry; postoperative imaging