Karel Jacobs1,2,3,4, Thibault Dewilde1,3, Cindy Vandoren1, Brecht Cardoen4,5, Nancy Vansteenkiste1, Lennart Scheys1,3, Filip Roodhooft6,7, Lieven Moke1,3, Katrien Kesteloot1,2. 1. University Hospitals Leuven, Leuven, Belgium. 2. KU Leuven, Faculty of Medicine, LIGB (Leuven Institute for Health Policy), Leuven, Belgium. 3. KU Leuven, Faculty of Medicine, Institute for Orthopaedic Research and Training, Leuven, Belgium. 4. Vlerick Business School, Technology and Operations Management, Gent, Belgium. 5. KU Leuven, Faculty of Economics and Business, Center for Operations Management, Leuven, Belgium. 6. KU Leuven, Faculty of Economics and Business, Research Centre Accountancy, Leuven, Belgium. 7. Vlerick Business School, Accounting and Finance, Gent, Belgium.
Abstract
STUDY DESIGN: Retrospective, single-center analysis. OBJECTIVE: To calculate the total clinical hospital cost of the Adult Spinal Deformity (ASD) care trajectory, to explain cost variability by patient and surgery characteristics, and to identify areas of process improvement opportunities. SUMMARY OF BACKGROUND DATA: ASD is associated with a high financial and clinical burden on society. ASD care thus requires improved insights in costs and its drivers as a critical step toward the improvement of value, i.e., the ratio between delivered health outcome and associated costs. METHODS: Patient characteristics and surgical variables were collected following ethical approval in a cohort of 139 ASD patients, treated between December, 2014 and January, 2018. Clinical hospital costs were calculated, including all care activities, from initial consultation to 1 year after initial surgery (excl. overhead) in a university hospital setting. Multiple linear regression analysis was performed to analyze the impact of patient and surgical characteristics on clinical costs. RESULTS: 75.5% of the total clinical hospital cost (&OV0556;27,865) was incurred during initial surgery with costs related to the operating theatre (80.3%), nursing units (11.9%), and intensive care (2.9%) being the largest contributors. 57.5% of the variation in total cost could be explained in order of importance by surgical invasiveness, age, coronary disease, single or multiple-staged surgery, and mobility status. Revision surgery, unplanned surgery due to complications, was found to increase average costs by 87.6% compared with elective surgeries (&OV0556; 44,907 (± &OV0556; 23,429) vs. &OV0556; 23,944 (± &OV0556; 7302)). CONCLUSION: This study identified opportunities for process improvement by calculating the total clinical hospital costs. In addition, it identified patient and treatment characteristics that predict 57.5% of cost variation, which could be taken into account when developing a payment system. Future research should include outcome data to assess variation in value. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Retrospective, single-center analysis. OBJECTIVE: To calculate the total clinical hospital cost of the Adult Spinal Deformity (ASD) care trajectory, to explain cost variability by patient and surgery characteristics, and to identify areas of process improvement opportunities. SUMMARY OF BACKGROUND DATA: ASD is associated with a high financial and clinical burden on society. ASD care thus requires improved insights in costs and its drivers as a critical step toward the improvement of value, i.e., the ratio between delivered health outcome and associated costs. METHODS:Patient characteristics and surgical variables were collected following ethical approval in a cohort of 139 ASDpatients, treated between December, 2014 and January, 2018. Clinical hospital costs were calculated, including all care activities, from initial consultation to 1 year after initial surgery (excl. overhead) in a university hospital setting. Multiple linear regression analysis was performed to analyze the impact of patient and surgical characteristics on clinical costs. RESULTS: 75.5% of the total clinical hospital cost (&OV0556;27,865) was incurred during initial surgery with costs related to the operating theatre (80.3%), nursing units (11.9%), and intensive care (2.9%) being the largest contributors. 57.5% of the variation in total cost could be explained in order of importance by surgical invasiveness, age, coronary disease, single or multiple-staged surgery, and mobility status. Revision surgery, unplanned surgery due to complications, was found to increase average costs by 87.6% compared with elective surgeries (&OV0556; 44,907 (± &OV0556; 23,429) vs. &OV0556; 23,944 (± &OV0556; 7302)). CONCLUSION: This study identified opportunities for process improvement by calculating the total clinical hospital costs. In addition, it identified patient and treatment characteristics that predict 57.5% of cost variation, which could be taken into account when developing a payment system. Future research should include outcome data to assess variation in value. LEVEL OF EVIDENCE: 4.
Authors: Katherine E Pierce; Bhaveen H Kapadia; Sara Naessig; Waleed Ahmad; Shaleen Vira; Carl Paulino; Michael Gerling; Peter G Passias Journal: Int J Spine Surg Date: 2021-12
Authors: Kevin Y Wang; Emmanuel L McNeely; Suraj A Dhanjani; Micheal Raad; Varun Puvanesarajah; Brian J Neuman; David Cohen; Akhil J Khanna; Floreana Kebaish; Hamid Hassanzadeh; Khaled M Kebaish Journal: Spine (Phila Pa 1976) Date: 2021-11-15 Impact factor: 3.241