title: Predictors of the charges for lumbar fusion surgery in Florida hospitals.
abstract: METHODS
  A mixed-effects model was used to evaluate the effects specific surgical procedure by International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code, patient age, sex, ethnic group, payers for the inpatient hospital stay, and number of additional diagnoses beyond the principal diagnosis that led to the procedure (as a proxy for severity of illness) on the charges for lumbar fusion surgery.
  
  
  OBJECTIVE
  The present research examined the charges and the predictors of the charges for lumbar fusion surgery in Florida hospitals in 2010.
  
  
  BACKGROUND
  The number of spinal fusion surgical procedures in the United States has grown exponentially in recent years despite the procedure's high costs and questionable efficacy for many of the principal diagnoses associated with it.
  
  
  METHODS
  All records with any of the 5 International Classification of Diseases, Ninth Revision, Clinical Modification, principal procedure codes for lumbar fusion were extracted (cases) from the Florida Agency for Health Care Administration (AHCA) hospital discharge data for the year 2010. A control group was obtained by taking all patients who had the same principal diagnoses as the cases, but who did not have fusion surgery. This produced 16,236 cases and 21,856 controls.
  
  
  RESULTS
  The total hospital charges for lumbar fusion surgery in Florida in 2010 were $2,095,413,584. Despite having the same principal diagnoses and a similar number of additional diagnoses, patients who underwent a fusion surgery had 3 times the charges as those incurred by the controls. The number of additional diagnoses, sex, age, payer, and principal procedure, were all found to be statistically significant predictors of charges. Ethnicity was not significant. Of all the predictors, the number of additional diagnoses was the most significant in the model (F=2577, P<0.0001).
  
  
  CONCLUSIONS
  The high incidence and charges for fusion surgical procedures shown in this study emphasize the need for a better understanding of when these surgical procedures are justified and for which patients.
  
  
  METHODS
  N/A.
authors.affiliation: *Department of Health Policy and Management, University of South Florida, Tampa †CINDRR, US Department of Veterans Affairs, Tampa, FL ‡Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; and §Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
authors.forename: Anna
authors.initials: A
authors.lastname: Ialynytchev
authors.forename: Alan M
authors.initials: AM
authors.lastname: Sear
authors.forename: Arthur R
authors.initials: AR
authors.lastname: Williams
authors.forename: Barbara
authors.initials: B
authors.lastname: Langland-Orban
authors.forename: Nanhua
authors.initials: N
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005431:Florida / Q000453:epidemiology; D005544:Forecasting; D017722:Hospital Charges / Q000639:trends; D006761:Hospitals / Q000639:trends; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000639:trends; D013123:Spinal Fusion / Q000191:economics*; D055815:Young Adult