General Session: Value and Outcomes in Spine Surgery
Presented by: F. Hijji - View Audio/Video Presentation (Members Only)
F. Hijji(1), D. Massel(1), B. Mayo(1), A. Narain(1), K. Kudaravalli(1), R. Burke(2), J. Canar(2), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
(2) Rush University Medical Center, Health Systems and Management, Chicago, IL, United States
Introduction: Hospital systems are experiencing significant pressure to increase value of care by reducing costs while maintaining or improving patient-centered outcomes. Few studies have examined the cost-effectiveness of cervical arthrodesis at a service level. In this context, the purpose of this study is to compare perioperative costs and outcomes of patients undergoing single-level anterior cervical discectomy and fusions (ACDF) at both a service (orthopedic versus neurosurgical) and individual surgeon level.
Methods: A retrospective review of patients who underwent a primary 1-level anterior cervical discectomy and fusion (ACDF) by eight surgeons (four orthopedic and four neurosurgical) at a single academic institution between 2013-2015 was performed. Patients were identified by diagnosis related group and procedural codes. Patients with the ninth revision of the International Classification of Diseases (ICD-9) coding for degenerative cervical pathology were included. Patients were excluded if they exhibited preoperative diagnoses or postoperative social work issues affecting their length of stay. Comparisons of preoperative demographics were performed using students t-tests and chi-squared analysis. Peri-operative outcomes and costs for hospital services were compared using multivariate regression adjusted for preoperative characteristics.
Results: A total of 137 patients diagnosed with cervical degeneration underwent single-level ACDF; 44 and 93 were performed by orthopaedic surgeons and neurosurgeons respectively. There was no difference in patient demographics. ACDF procedures performed by orthopaedic surgeons demonstrated shorter operative times (89.1±25.5 vs 96.0±25.5 min; p=0.002) and higher laboratory costs (Δ+$6.53±5.52 USD;p=0.041). There were significant differences in operative time (p=0.014) and labor costs (p=0.034) between individual surgeons. There was no difference in total direct costs between specialties or individual surgeons.
Conclusions: Surgical subspecialty training does not significantly impact total costs of ACDF procedures. However, costs can vary between individual surgeons based on operative times. Variation between individual surgeons highlights potential areas for improvement of the cost effectiveness of spinal procedures.