Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Parker, Scott L.; Shau, David N.; Mendenhall, Stephen K.; McGirt, Matthew J.

doi:10.3171/2011.12.spine11750

Cited by 62 publications

(48 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In neurosurgery a simple wound infection may lead to multiple reoperations and long antibiotic treatments, and hence cause greater costs than infections in other surgical specialties. 15,25 The use of a surgical checklist is simple and inexpensive, and could indirectly save money, 18 redundant work, and suffer ing of patients. There is a need for surgical checklists in all types of surgery, 13 but especially in neurosurgery.…”

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Lepänluoma

Rahi

Takala

et al. 2015

JNS

View full text Add to dashboard Cite

OBJECT Use of the WHO surgical checklist has been proven to reduce surgical morbidity and mortality, but its effect on surgical complications requiring reoperation has not been previously studied. The aim of this study was to determine whether the use of the WHO surgical checklist would have an impact on the number and causes of neurosurgical complications leading to a reoperation. METHODS The authors retrospectively gathered information on all neurosurgical reoperations using hospital discharge data as well as the operations and procedures registry, and tracked all primary neurosurgical operations (n = 175) preceding a complication-related reoperation from 2007 to 2011. There were a total of 5418 neurosurgical operations during the study period. For further analysis of electronic patient records, the primary operations were divided into 2 groups based on the time of the WHO surgical checklist implementation in the authors' unit: 103 operations before and 72 after the introduction of the checklist. Observed adverse events and reoperations were categorized as preventable or unpreventable, and the actual use of the checklist during each operation was recorded. RESULTS The overall rate of preventable complication-related neurosurgical reoperations decreased from 3.3% (95% CI 2.7%–4.0%) to 2.0% (95% CI 1.5%–2.6%) after the checklist implementation. The reoperations were mainly due to wound infections, 46% before and 39% after the checklist. All infection-related reoperations proportioned to all neurosurgical operations (2.5% before vs 1.6% after checklist implementation) showed a significant reduction (p = 0.02) after the implementation of the checklist. In particular, there was a significant decrease (p = 0.006) in the rate of preventable infections associated with reoperations, i.e., 2.2% before versus 1.2% after checklist implementation. The overall adherence to checklist use (the “time out” phase) in neurosurgical operations was 78%, and adherence was 70% in primary operations preceding a complication-related reoperation regarded as preventable. CONCLUSIONS The implementation of the WHO surgical checklist in neurosurgery was associated with a decrease in complication-related reoperations, especially those due to preventable infection complications, the majority of which were wound infections. The adherence to checklist use in individual operations after the checklist implementation did not appear to have an impact on the results.

show abstract

Section: Discussionmentioning

confidence: 99%

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Lepänluoma

Rahi

Takala

et al. 2015

JNS

View full text Add to dashboard Cite

show abstract

“…56 Other citations describe the cost of revision lumbar decompression and fusion surgery, but this is likely more expensive than straightforward screw revision. 2,39 Thus, the lower end of the cost spectrum was used in our model for the cost of returning to the operating room for screw revision. A sensitivity analysis was performed by varying the cost per screw ($600-$1000 per screw).…”

Section: Methodsmentioning

confidence: 99%

“…The cost of return to the operating room for screw malposition was set at $23,762 2,39,56 (Table 2). There is only 1 paper that provides cost data regarding screw revision surgery.…”

Section: Methodsmentioning

confidence: 99%

“…16,17,45,53 A recent structured literature review reveals a wide variety in the mean implant density reported in clinical practice. 39 Implant densities varied from 1.04 to 2.0 screws per level fused, while in the same studies the mean percentage of major Cobb angle correction only varied from 64% to 70%. 40 With the introduction of pedicle screws, the cost of scoliosis surgery has increased due to high implant expenses, 41 which comprise on average 29% of the total hospital costs incurred during primary scoliosis surgery.…”

mentioning

confidence: 99%

See 1 more Smart Citation

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Larson

Polly

Ackerman

et al. 2016

SPI

View full text Add to dashboard Cite

OBJECT There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis. METHODS Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern. RESULTS The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations). CONCLUSIONS Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

show abstract

“…However, this method requires extensive soft tissue dissection to expose the previously implanted hardware, adding to surgical blood loss and postoperative pain and prolonging recovery with high associated health care costs. 13 For example, Smorqick et al found that revision posterior surgery involved a mean blood loss of 1606 ml, 16% greater than in similar primary surgeries. 15 The surgeon will typically have to explant or attach onto the previous hardware construct, expanding the surgical enterprise.…”

mentioning

confidence: 99%

Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation

Wang

Vasudevan

Mindea

2014

SPI

View full text Add to dashboard Cite

Object Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously implanted instrumentation. A minimally invasive lateral approach allows the surgeon to potentially reduce the risk of these hazards. The technique relies on indirect decompression to treat central and foraminal stenosis and placement of a graft with a large surface area to promote robust fusion and stability in concert with the surrounding tensioned ligaments. The goal in this study was to determine if lateral interbody fusion without supplemental pedicle screws is effective in treating adjacent-segment disease. Methods For a 30-month study period at two institutions, the authors obtained all cases of lumbar fusion with new back and leg pain due to adjacent-segment stenosis and spondylosis failing conservative measures. All patients had undergone minimally invasive lateral interbody fusion from the side of greater leg pain without supplemental pedicle screw fixation. Patients were excluded from the study if they had undergone surgery for a nondegenerative etiology such as infection or trauma. They were also excluded if the intervention involved supplemental posterior instrumented fusion with transpedicular screws. Postoperative metrics included numeric pain scale (NPS) scores for leg and back pain. All patients underwent dynamic radiographs and CT scanning to assess stability and fusion after surgery. Results During the 30-month study period, 21 patients (43% female) were successfully treated using minimally invasive lateral interbody fusion without the need for subsequent posterior transpedicular fixation. The mean patient age was 61 years (range 37–87 years). Four patients had two adjacent levels fused, while the remainder had single-level surgery. All patients underwent surgery without conversion to a traditional open technique, and recombinant human bone morphogenetic protein–2 was used in the interbody space in all cases. The mean follow-up was 23.6 months. The mean operative time was 86 minutes, and the mean blood loss was 93 ml. There were no major intraoperative complications, but one patient underwent subsequent direct decompression in a delayed fashion. The leg pain NPS score improved from a mean of 6.3 to 1.9 (p < 0.01), and the back pain NPS score improved from a mean of 7.5 to 2.9 (p < 0.01). Intervertebral settling averaged 1.7 mm. All patients had bridging bone on CT scanning at the last follow-up, indicating solid bony fusion. Conclusions Adjacent-segment stenosis and spondylosis can be treated with a number of different operative techniques. Lateral interbody fusion provides an attractive alternative with reduced blood loss and complications, as there is no need to re-explore a previous laminectomy site. In this limited series a minimally invasive lateral approach provided high fusion rates when performed with osteobiological adjuvants.

show abstract

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

Cited by 62 publications

References 33 publications

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

Analysis of neurosurgical reoperations: use of a surgical checklist and reduction of infection-related and preventable complication-related reoperations

What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation

Contact Info

Product

Resources

About