Cost Analysis of Single-Level Lumbar Fusions

Abstract

Study Design: Cost analysis of a retrospectively identified cohort of patients who had undergone primary single-level lumbar fusion at a single institution’s orthopedic or neurosurgery department. Objective: The purpose of this article is to analyze the determinants of direct costs for single-level lumbar fusions and identify potential areas for cost reduction. Methods: Adult patients who underwent primary single-level lumbar fusion from fiscal years 2008 to 2012 were identified via administrative and departmental databases and were eligible for inclusion. Patients were excluded if they underwent multiple surgeries, had previous surgery at the same anatomic region, underwent corpectomy, kyphectomy, disc replacement, surgery for tumor or infection, or had incomplete cost data. Demographic data, surgical data, and direct cost data in the categories of supplies, services, room and care, and pharmacy, was collected for each patient. Results: The cohort included 532 patients. Direct costs ranged from $8286 to $73 727 (median = $21 781; mean = $22 890 ± $6323). Surgical approach was an important determinant of cost. The mean direct cost was highest for the circumferential approach and lowest for posterior instrumented spinal fusions without an interbody cage. The difference in mean direct cost between transforaminal lumbar interbody fusions, anterior lumbar interbody fusions, and lateral transpsoas fusions was not statistically significant. Surgical supplies accounted for 44% of direct costs. Spinal implants were the primary component of supply costs (84.9%). Services accounted for 38% of direct costs and were highly dependent on operative time. Comorbidities were an important contributor to variance in the cost of care as evidenced by high variance in pharmacy costs and length of stay related to their management. Conclusion: The costs of spinal surgeries are highly variable. Important cost drivers in our analysis included surgical approach, implants, operating room time, and length of hospital stay. Areas of high cost and high variance offer potential targets for cost savings and quality improvements.

Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome

“…They found that the use of an interbody device represented a high portion of the direct cost for instrumented fusions. 3 Malik et al studied the overall 90-day cost for Medicare patients who underwent ALIF surgery and reported that 76.4% of the cost were related to facility charges, 11.5% for surgeon fees, 7.4% for readmission cost, 0.9% for hospitalization services, 1.7% for anesthesia, 0.3% for imaging, 0.7% for office visits, 0.6% for physical therapy and rehab, and 0.5% for emergency department visits. 6 Overall major costs in lumbar fusion are driven by facility charges and cost of supplies and implants.…”

“… 1 The drivers of cost in instrumented spine surgery are varied and include implant costs, complications, readmissions, facility-based costs, surgeon-driven preferences, and patient comorbidities. 2 - 8 Each major cost driver represents an opportunity for potential reductions in cost. With high resource utilization and often uncertain outcomes, spinal surgery has been heavily scrutinized by payers and hospital systems, with efforts to reduce costs and standardize surgical approach and care pathways.…”

Evaluation of factors driving cost variation for distal humerus open reduction internal fixation

“…Not surprisingly, increased surgical time increased costs 5 , 10 , 19 , 21 associated with distal humerus ORIF. Each additional hour of operating time increased costs by 15%.…”

“…Measures to address sources of cost variation may improve the value of care delivered to patients. 5 , 6 , 7 , 16 , 19 , 45 …”

Economical aspects of intraoperative blood loss in a large spinal surgical ward in 2018

“…Rampersaud et al demonstrated its relevancy to health care costs because of its amount: $330 million (CDN) were spent in Ontario, Canada, on patient care regarding spinal conditions (including degenerative/traumatic aetiologies, outpatient visits/emergency department/imaging) [5]. Beckerman et al showed that in singlelevel lumbar fusions 9% (lateral transpsoasfusion ("lateral"-extreme lateral [XLIF]/direct lateral [DLIF]/lumbar lateral [LLIF]) to 17,6% (posterolateral fusion) of overall direct health care costs were solely for room and care [6].…”