Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p &lt; 0.001), combined anterior-posterior approach (p &lt; 0.001), presence of a perioperative complication (p &lt; 0.001), and longer hospital stay (p &lt; 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.</jats:p></jats:sec>

Cost-Utility Analysis of Surgery and Radiotherapy for Symptomatic Spinal Metastases in a Belgian Specialist Center

“…24,25 A worse preoperative condition and greater number of complications are particularly associated with higher non-medical staffing and operational costs. A similar observation was made in the cost analysis by Lau et al, 10 and explained this by the more extensive surgeries performed in these patients. 9 The latter is reflected in our finding of higher costs associated with slower growing tumors, which is likely to be explained by more aggressive surgeries performed in these patients.…”

“…Several studies have reported costs of surgery for spinal metastases, and figures vary widely: €15,267 for both inpatient care and outpatient follow up in a Belgian study using Diagnosis Related Groups (DRG) codes and national tariffs 8 , an average inpatient cost of £16,885 in a United Kingdom study with patient-level actual costs, 9 but an average of $50,098 for direct costs to the hospital for inpatient stays in a San Francisco study, 10 and an average total of €87,814 over a lifetime horizon in a Danish study. 11 Detailed cost-utility analyses comparing surgical versus non-surgical approaches were performed by three authors.…”

Healthcare Resource Utilization and Patient-Reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

“…Few studies have discussed healthcare utilization associated with intradural spinal tumors 14,15,24,41 as compared to multiple studies assessing costs in the treatment of metastatic epidural spinal cord compression. [25][26][27]42,43 Sharma et al 14 reported that the mean total hospital charges for treating intramedullary spine tumors in the National Inpatient Sample from 2003 to 2010 was $61 157.…”

Treatment, complications, and outcomes of metastatic disease of the spine: from Patchell to PROMIS

“…Prior hospitalization of 15 days and lung metastases were independent risk factors for readmission. Another single center study of 181 patients with both primary and metastatic tumors reported an overall perioperative complication rate or 21.0% with 11.9% 90-day readmissions, costing approximately $20,000 each (50). Other factors that may affect complication rates include patient age and location of spinal metastases.…”