TY - JOUR
T1 - Preoperative and Postoperative Spending Among Working-Age Adults Undergoing Posterior Spinal Fusion Surgery for Degenerative Disease
AU - Marrache, Majd
AU - Harris, Andrew B.
AU - Raad, Micheal
AU - Puvanesarajah, Varun
AU - Pakpoor, Jina
AU - Bicket, Mark
AU - Hassanzadeh, Hamid
AU - Jain, Amit
PY - 2020/6
Y1 - 2020/6
N2 - Objective: To investigate the health care resource utilization and the associated 6 months preoperative and 6 months postoperative spending among patients undergoing posterior lumbar fusion. Methods: We retrospectively reviewed a private insurance claims database for patients who underwent single-level posterior spinal fusion from January 2011 to December 2015. Outpatient health services, prescription pain medications, and inpatient admissions were assessed. Results: Among 25,401 patients (mean age, 52 years; 58% female) in the final cohort, median spending during the period from 6 months before surgery to 6 months after surgery was $60,714 (interquartile range [IQR], $46,961–$79,892)/patient. Preoperative spending accounted for 7% ($121 million) of the total costs, and postoperative spending accounted for 8% ($135 million). Median preoperative spending was $3566 (IQR, $2144–$5857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. In the 6 months period preceding surgery, 46% patients received injections and 47% received physical therapy. The median postoperative spending was $1954/patient (IQR, $735–$4416). Total postoperative spending was significantly higher among those not discharged home (median, $7525; IQR, $6779–$19,602) compared with those discharged home (median, $1617/patient; IQR, $648–$4033) and home with home care services (median, $2921; IQR, $1406–$5662) (P < 0.001). Conclusions: Unplanned readmission after posterior spinal fusion was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the preoperative and postoperative period in patients undergoing single-level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost containment.
AB - Objective: To investigate the health care resource utilization and the associated 6 months preoperative and 6 months postoperative spending among patients undergoing posterior lumbar fusion. Methods: We retrospectively reviewed a private insurance claims database for patients who underwent single-level posterior spinal fusion from January 2011 to December 2015. Outpatient health services, prescription pain medications, and inpatient admissions were assessed. Results: Among 25,401 patients (mean age, 52 years; 58% female) in the final cohort, median spending during the period from 6 months before surgery to 6 months after surgery was $60,714 (interquartile range [IQR], $46,961–$79,892)/patient. Preoperative spending accounted for 7% ($121 million) of the total costs, and postoperative spending accounted for 8% ($135 million). Median preoperative spending was $3566 (IQR, $2144–$5857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. In the 6 months period preceding surgery, 46% patients received injections and 47% received physical therapy. The median postoperative spending was $1954/patient (IQR, $735–$4416). Total postoperative spending was significantly higher among those not discharged home (median, $7525; IQR, $6779–$19,602) compared with those discharged home (median, $1617/patient; IQR, $648–$4033) and home with home care services (median, $2921; IQR, $1406–$5662) (P < 0.001). Conclusions: Unplanned readmission after posterior spinal fusion was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the preoperative and postoperative period in patients undergoing single-level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost containment.
KW - Degenerative disc disease
KW - Health care costs
KW - Health care utilization
KW - Health economics
KW - Hospital costs
KW - Posterior spinal fusion
KW - Spine surgery
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U2 - 10.1016/j.wneu.2020.03.143
DO - 10.1016/j.wneu.2020.03.143
M3 - Article
C2 - 32251816
AN - SCOPUS:85083586711
SN - 1878-8750
VL - 138
SP - e930-e939
JO - World neurosurgery
JF - World neurosurgery
ER -