title: Cost of Surgery for Symptomatic Spinal Metastases in the United Kingdom.
abstract: BACKGROUND
  Spinal metastases represent a significant health and economic burden. The average cost of surgical management varies between institutions and countries, partially a result of differences in health care system billing. This study assessed hospital costs from a single institute in the United Kingdom National Healthcare Service and identified patient factors associated with these costs.
  
  
  METHODS
  This prospective study recruited patients with confirmed symptomatic spinal metastases who presented for surgical treatment. The primary outcome was cost of inpatient treatment collected using the Patient Level Costing and Information System; preoperative details collected included patient demographics, primary tumor type, Tomita and Tokuhashi scores, pain level, EuroQol 5 dimension score, Frankel, Karnofsky, and American Society of Anesthesiologists' physical status classification system scores, and operative details.
  
  
  RESULTS
  Costs were analyzed for 74 patients. The mean cost of treatment (standard deviation, SD) per patient was £ 16,885 (£ 10,687); which was mainly comprised of operating theater (25% of the total) and ward costs (27%). Better health status at presentation significantly increased total and ward costs (Frankel score P = 0.006, and EuroQol 5 dimension index P = 0.014 respectively); male sex also increased total and ward costs (P < 0.01 and P = 0.06). Operation cost showed a trend to increased costs with less impairment on American Society of Anesthesiologists' physical status classification system scores.
  
  
  CONCLUSIONS
  The cost of surgical management of spinal metastases is associated with several factors but is greater in patients presenting with better health status, probably because of their suitability for larger operations, whereas those with poor health status undergo smaller, palliative operations, resulting in shorter inpatient postoperative recovery.
authors.affiliation: Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom. Electronic address: Isobel.Turner1@nhs.net.
authors.forename: Isobel
authors.initials: I
authors.lastname: Turner
authors.affiliation: Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Minhas
authors.affiliation: Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kennedy
authors.affiliation: Department of Applied Health Research, University College London, London, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Crockard
authors.affiliation: Neurosurgery Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Choi
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D006304:Health Status; D017721:Hospital Costs; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000191:economics*; D009873:Operating Rooms / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012737:Sex Factors; D013125:Spinal Neoplasms / Q000191:economics / Q000556:secondary* / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Cost; Metastases; PLICS; Skeletal-related event; Spine; Surgery