#520 Resource Utilization for Anterior Compared to Posterior Surgical Approaches for Cervical Spondylotic Myelopathy: An Analysis of Private Payer and Medicare Databases
Value and Outcomes in Spine Surgery
Poster Presented by: S. Virk
S. Virk (1)
F. Phillips (2)
S. Khan (1)
(1) Ohio State University, Orthopaedics, Columbus, OH, United States
(2) Rush University Medical Center, Orthopaedics, Chicago, IL, United States
Purpose: Cervical spondylotic myelopathy (CSM) is a progressive spinal condition that often necessitates surgery. The purpose of this study was to determine the amount and type of resources used for anterior compared to posterior surgical treatment of CSM using large national databases.
Methods: Subjects were selected from a database of patients with Medicare (SAF5) and another database of patients with private payer health insurance (HORTHO). The outcome measures were cost of a 90-day episode of care as well as a breakdown of cost components for each surgical procedure between 2005 and 2014. A total of 16,444 patients were included within this analysis. Within the HORTHO database there were 10,332 and 1,556 patients treated with an anterior or posterior approach for CSM, respectively. Within the SAF5 database there were 3,851 and 705 patients treated by an anterior or posterior approach for CSM respectively.
Results: The average reimbursement for anterior vs. posterior approaches within the HORTHO database was $20,863 (+/- 2,014) and $23,813(+/- $4,258) respectively (p= 0.048). The average reimbursement for anterior vs. posterior approaches within the SAF5 database was $18,219 (+/- $1,053) and 25,598 (+/- $1,686) respectively (p= < 0.0001). In all cohorts within this study, the hospital-related reimbursement more than doubled the surgeon-related reimbursement.
Conclusions: Understanding reimbursement patterns for anterior versus posterior approaches for CSM will help providers design a bundled payment for patients requiring surgery for CSM and suggests that a subset of patients requiring a posterior approach for treatment require greater resources.