Jennifer K Workman1, Jacob Wilkes2, Angela P Presson3, Yizhe Xu4, John A Heflin5, John T Smith5. 1. Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT. 2. Pediatric Clinical Program, Intermountain Healthcare, Salt Lake City, UT. 3. Department of Pediatrics, Division of Critical Care Medicine, University of Utah School of Medicine, Salt Lake City, UT; Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT. 4. Division of Epidemiology, Department of Population Health Science, University of Utah, Salt Lake City, UT. 5. Department of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Abstract
OBJECTIVES: To investigate the variation in care and cost of spinal fusion for adolescent idiopathic scoliosis (AIS), and to identify opportunities for improving healthcare value. STUDY DESIGN: Retrospective cohort study from the Pediatric Health Information Systems database, including children 11-18 years of age with AIS who underwent spinal fusion surgery between 2004 and 2015. Multivariable regression was used to evaluate the relationships between hospital cost, patient outcomes, and resource use. RESULTS: There were 16 992 cases of AIS surgery identified. There was marked variation across hospitals in rates of intensive care unit admission (0.5%-99.2%), blood transfusions (0%-100%), surgical complications (1.8%-32.3%), and total hospital costs ($31 278-$90 379). Hospital cost was 32% higher at hospitals that most frequently admitted patients to the intensive care unit (P = .009), and 8% higher for each additional 25 operative cases per hospital (P = .003). Hospital duration of stay was shorter for patients admitted to hospitals with highest intensive care unit admission rates and higher surgical volumes. There was no association between cost and duration of stay, 30-day readmission, or surgical complications. The largest contribution to hospital charges was supplies (55%). Review of a single hospital's detailed cost accounting system also found supplies to be the greatest single contributor to cost, the majority of which were for spinal implants, accounting for 39% of total hospital costs. CONCLUSIONS: The greatest contribution to AIS surgery cost was supplies, the majority of which is likely attributed to spinal implant costs. Opportunities for improving healthcare value should focus on controlling costs of spinal instrumentation, and improving quality of care with standardized treatment protocols.
OBJECTIVES: To investigate the variation in care and cost of spinal fusion for adolescent idiopathic scoliosis (AIS), and to identify opportunities for improving healthcare value. STUDY DESIGN: Retrospective cohort study from the Pediatric Health Information Systems database, including children 11-18 years of age with AIS who underwent spinal fusion surgery between 2004 and 2015. Multivariable regression was used to evaluate the relationships between hospital cost, patient outcomes, and resource use. RESULTS: There were 16 992 cases of AIS surgery identified. There was marked variation across hospitals in rates of intensive care unit admission (0.5%-99.2%), blood transfusions (0%-100%), surgical complications (1.8%-32.3%), and total hospital costs ($31 278-$90 379). Hospital cost was 32% higher at hospitals that most frequently admitted patients to the intensive care unit (P = .009), and 8% higher for each additional 25 operative cases per hospital (P = .003). Hospital duration of stay was shorter for patients admitted to hospitals with highest intensive care unit admission rates and higher surgical volumes. There was no association between cost and duration of stay, 30-day readmission, or surgical complications. The largest contribution to hospital charges was supplies (55%). Review of a single hospital's detailed cost accounting system also found supplies to be the greatest single contributor to cost, the majority of which were for spinal implants, accounting for 39% of total hospital costs. CONCLUSIONS: The greatest contribution to AIS surgery cost was supplies, the majority of which is likely attributed to spinal implant costs. Opportunities for improving healthcare value should focus on controlling costs of spinal instrumentation, and improving quality of care with standardized treatment protocols.
Authors: Xue Li; Zhaohua Huo; Zongshan Hu; Tsz Ping Lam; Jack Chun Yiu Cheng; Vincent Chi-Ho Chung; Benjamin Hon Kei Yip Journal: PLoS One Date: 2022-07-20 Impact factor: 3.752
Authors: David W Polly; A Noelle Larson; Amer F Samdani; William Rawlinson; Hannah Brechka; Alex Porteous; William Marsh; Richard Ditto Journal: Clinicoecon Outcomes Res Date: 2021-03-15