title: Geographic variations in the cost of spine surgery.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To define the geographic variation in costs of anterior cervical discectomy and fusion (ACDF) and posterolateral fusion (PLF).
  
  
  BACKGROUND
  ACDF and lumbar PLF are common procedures that are used in the treatment of spinal pathologies. To optimize value, both the benefits and costs of an intervention must be quantified. Data on costs are scarce in comparison with data on total charges. This study aims at defining the costs of ACDF and PLF and describing the geographic variation within the United States.
  
  
  METHODS
  Medicare Provider Utilization and Payment data were used to investigate the costs associated with ACDF, PLF, and total knee arthroplasty (TKA). Average total costs of the procedures were compared by state and geographic region.
  
  
  RESULTS
  Combined professional and facility costs for a single-level ACDF had a national mean of $13,899. Total costs for a single-level PLF had a mean of $25,858. Total costs for a primary TKA had a national mean of $13,039. The cost increased to an average of $22,138 for TKA with major comorbidities. Analysis of geographic trends showed statistically significant differences in total costs of PLF, TKA, and TKA, with major complications or comorbidities between geographic regions (P < 0.01 for all).
  
  
  CONCLUSIONS
  Three of the 4 procedures (PLF, TKA, and TKA with major complications or comorbidities) showed statistically significant variation in cost between geographic regions. The Midwest provided the lowest cost for all procedures. Similar geographic trends in the cost of spinal fusions and TKAs suggest that these trends may not be limited to spine-related procedures. Surgical costs were found to correlate with cost of living but were not associated with the population of the state. These data shed light on the actual cost of common surgical procedures throughout the United States and will allow further progress toward the development of cost-effective, value-driven care.
  
  
  METHODS
  3.
authors.affiliation: From the Department of Orthopaedics, The University of Utah, Salt Lake City, UT.
authors.forename: Vadim
authors.initials: V
authors.lastname: Goz
authors.forename: Ajinkya
authors.initials: A
authors.lastname: Rane
authors.forename: Amir M
authors.initials: AM
authors.lastname: Abtahi
authors.forename: Brandon D
authors.initials: BD
authors.lastname: Lawrence
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: William Ryan
authors.initials: WR
authors.lastname: Spiker
mesh_terms: D002574:Cervical Vertebrae / Q000601:surgery*; D003362:Cost-Benefit Analysis; D017586:Diskectomy / Q000191:economics* / Q000379:methods; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics*; D014481:United States