Samrat Yeramaneni1, Christopher P Ames2, Shay Bess3, Doug Burton4, Justin S Smith5, Steven Glassman6, Jeffrey L Gum7, Leah Carreon7, Amit Jain8, Corinna Zygourakis9, Ioannis Avramis10, Richard Hostin10. 1. Center for Clinical Effectiveness, Baylor Scott & White Health, 8080 N. Central Expressway, Dallas, TX, 75206, USA. Electronic address: samrat.yeramaneni@bswhealth.org. 2. Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Ave, Room 779 M, San Francisco, CA, 94143-0112, USA. 3. Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St Luke's/Rocky Mountain Hospital for Children, 1601 E. 19th Ave Suite 6250, Denver, CO 80128, USA. 4. Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66103, USA. 5. Department of Neurosurgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA. 6. Department of Orthopedic Surgery, University of Louisville Medical Center, 550 S. Jackson St, 1st Floor ACB, Louisville, KY, 40202, USA. 7. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. 8. Department of Orthopedic Surgery, The Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287, USA. 9. Department of Neurosurgery, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD, 21287, USA. 10. Department of Orthopedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd, Suite 800, Plano, TX, 75093, USA.
Abstract
BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgery is associated with significant resource utilization, costing more than $958 million in charges for Medicare patients and more than $1.7 billion in charges for managed care population in the last decade. Given the recent move toward bundled payment models, it is important to understand the various care components a patient receives over the course of a defined clinical episode, its associated cost, and the proportion of cost for each component toward the bundled payment. PURPOSE: To examine the degree and determinants of variation in inpatient episode-of-care (EOC) cost, resource utilization, and patient-reported outcomes for patients undergoing ASD surgery across four spine deformity centers in the United States. STUDY DESIGN/ SETTING: Retrospective analysis of prospective, multicenter database. PATIENT SAMPLE: Consecutive patients enrolled in an ASD database from four spinal deformity centers. OUTCOME MEASURES: Total in-patient EOC costs and Short Form (SF)-6D. METHODS: The study used a multicenter database of 210 consecutively enrolled operative patients from 2008 to 2013 at four participating centers in the United States. Demographic, surgical, and direct cost data, expressed in 2013 dollars, for the entire inpatient EOC were obtained from administrative databases from the respective hospitals. Mixed models and multivariable linear regression were used to evaluate the impact of center on total costs adjusting for patient characteristics, length of stay (LOS), and surgical factors. RESULTS: A total of 126 patients with complete baseline and 2-year follow-up data were included. The percentages of patients from each center were 36.5%, 7.1%, 24.6%, and 31.7%. Overall, the mean patient age was 58.4±12.6 years, 86% were women, and 94% were Caucasian. The proportion of total cost variation explained by the center at which the patient was treated was 17%. After adjusting for patient, LOS, and surgical factors the cost variation reduced to 4%. In multivariable analysis, each additional level fused increased total cost variation by $2,500, whereas recombinant human bone morphogenetic protein-2 (BMP) use and posterior-only surgical approach lowered total EOC costs by $10,500 and $9,400, respectively. No significant difference was observed in 2-year quality-adjusted life year across centers. CONCLUSIONS: Total EOC costs for ASD surgery varied significantly by center. Levels fused, BMP use, and surgical approach were the primary drivers of cost variation across centers. Differences in resource utilization had no impact on 2-year quality-adjusted life year improvement across centers.
BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgery is associated with significant resource utilization, costing more than $958 million in charges for Medicare patients and more than $1.7 billion in charges for managed care population in the last decade. Given the recent move toward bundled payment models, it is important to understand the various care components a patient receives over the course of a defined clinical episode, its associated cost, and the proportion of cost for each component toward the bundled payment. PURPOSE: To examine the degree and determinants of variation in inpatient episode-of-care (EOC) cost, resource utilization, and patient-reported outcomes for patients undergoing ASD surgery across four spine deformity centers in the United States. STUDY DESIGN/ SETTING: Retrospective analysis of prospective, multicenter database. PATIENT SAMPLE: Consecutive patients enrolled in an ASD database from four spinal deformity centers. OUTCOME MEASURES: Total in-patient EOC costs and Short Form (SF)-6D. METHODS: The study used a multicenter database of 210 consecutively enrolled operative patients from 2008 to 2013 at four participating centers in the United States. Demographic, surgical, and direct cost data, expressed in 2013 dollars, for the entire inpatient EOC were obtained from administrative databases from the respective hospitals. Mixed models and multivariable linear regression were used to evaluate the impact of center on total costs adjusting for patient characteristics, length of stay (LOS), and surgical factors. RESULTS: A total of 126 patients with complete baseline and 2-year follow-up data were included. The percentages of patients from each center were 36.5%, 7.1%, 24.6%, and 31.7%. Overall, the mean patient age was 58.4±12.6 years, 86% were women, and 94% were Caucasian. The proportion of total cost variation explained by the center at which the patient was treated was 17%. After adjusting for patient, LOS, and surgical factors the cost variation reduced to 4%. In multivariable analysis, each additional level fused increased total cost variation by $2,500, whereas recombinant humanbone morphogenetic protein-2 (BMP) use and posterior-only surgical approach lowered total EOC costs by $10,500 and $9,400, respectively. No significant difference was observed in 2-year quality-adjusted life year across centers. CONCLUSIONS: Total EOC costs for ASD surgery varied significantly by center. Levels fused, BMP use, and surgical approach were the primary drivers of cost variation across centers. Differences in resource utilization had no impact on 2-year quality-adjusted life year improvement across centers.
Authors: Jeffrey L Gum; Breton Line; Leah Y Carreon; Richard A Hostin; Samrat Yeramaneni; Steven D Glassman; Douglas L Burton; Justin S Smith; Christopher I Shaffrey; Peter G Passias; Virginie Lafage; Christopher P Ames; R Shay Bess Journal: Spine Deform Date: 2021-09-01
Authors: David M Gullotti; Amir H Soltanianzadeh; Saki Fujita; Miguel Inserni; Edward Ruppel; Nicholas G Franconi; Corinna Zygourakis; Themistocles Protopsaltis; Sheng-Fu Larry Lo; Daniel M Sciubba; Nicholas Theodore Journal: Global Spine J Date: 2022-04
Authors: Majd Marrache; Andrew B Harris; Varun Puvanesarajah; Micheal Raad; Hamid Hassanzadeh; Lee H Riley; Richard L Skolasky; Mark Bicket; Amit Jain Journal: Global Spine J Date: 2020-01-14