LaCaille Rick A, DeBerard M Scott, LaCaille Lara J, Masters Kevin S, Colledge Alan L
Department of Psychology, University of Minnesota Duluth, 1207 Ordean Court, Duluth, MN 55812, USA.
Spine J. 2007 May-Jun;7(3):266-72. doi: 10.1016/j.spinee.2006.05.014. Epub 2007 Mar 26.
Results of lumbar fusion surgery have been mixed and procedures are costly. Interbody cage lumbar fusion (ICLF) has been advanced to improve arthrodesis and clinical outcomes; however, little attention has been given to ICLF costs or potential predictors of these expenses.
To depict medical and compensation costs associated with ICLF in a Utah cohort of patients receiving workers' compensation as well as to investigate predictors of costs.
STUDY DESIGN/SETTING: A retrospective-cohort research design was used involving completion of presurgical and postsurgical medical record reviews and accrual of medical and compensation costs. Presurgical variables included in a regression model were presurgical spinal pathophysiology rating, obesity, and litigation status.
Forty-three consecutive patients who were compensated by the Workers' Compensation Fund of Utah and underwent ICLF.
Total accrued compensation and medical costs.
A retrospective review of presurgical variables and total accrued compensation and medical costs was conducted.
Multiple regression analysis indicated that nonpathophysiological factors predicted compensation costs (lawyer involvement [beta=0.40]; obesity [beta=0.34]). Specifically, compensation for those with versus without lawyers was $41,657 versus $24,837, and for those who were obese versus nonobese was $46,152 versus $28,168. Arthrodesis was correlated with medical costs (r=-0.47, p=.002), with incurred costs for patients achieving solid fusion versus pseudarthrosis equaling $38,881 versus $71,655, respectively.
Considerable costs were associated with ICLF, particularly for those who were obese, involved in litigation, or failed to achieve solid fusion. With regard to compensation costs, the findings support the importance of assessing nonpathophysiological factors in spinal fusion patients.
腰椎融合手术的结果参差不齐，且手术费用高昂。椎间融合器腰椎融合术（ICLF）已被推广以改善融合效果和临床疗效；然而，ICLF的成本或这些费用的潜在预测因素却很少受到关注。
描述犹他州一组接受工伤赔偿的患者中与ICLF相关的医疗和赔偿费用，并调查成本的预测因素。
研究设计/地点：采用回顾性队列研究设计，包括完成术前和术后病历审查以及计算医疗和赔偿费用。回归模型中纳入的术前变量包括术前脊柱病理生理学评分、肥胖和诉讼状态。
43例连续接受犹他州工伤赔偿基金赔偿并接受ICLF的患者。
累计赔偿和医疗费用总额。
对术前变量以及累计赔偿和医疗费用总额进行回顾性分析。
多元回归分析表明，非病理生理因素可预测赔偿费用（律师介入[β=0.40]；肥胖[β=0.34]）。具体而言，有律师介入的患者与无律师介入的患者的赔偿金额分别为41,657美元和24,837美元，肥胖患者与非肥胖患者的赔偿金额分别为46,152美元和28,168美元。融合与医疗费用相关（r=-0.47，p=0.002），实现牢固融合的患者与假关节形成患者的医疗费用分别为38,881美元和71,655美元。
ICLF相关费用高昂，尤其是肥胖、涉及诉讼或未实现牢固融合的患者。关于赔偿费用，研究结果支持在脊柱融合患者中评估非病理生理因素的重要性。
