Whang Peter G, Lim Moe R, Sasso Rick C, Skelton Alta, Brown Zoe B, Greg Anderson David, Albert Todd J, Hilibrand Alan S, Vaccaro Alexander R
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA.
J Spinal Disord Tech. 2008 Aug;21(6):381-6. doi: 10.1097/BSD.0b013e31814d4e1b.
Retrospective case-control study/economic analysis.
To determine the treatment times required for isolated lumbar decompressions and for combined decompression and instrumented fusion procedures to compare the relative reimbursements for each type of operation as a function of time expenditure by the surgeon.
Under current Medicare fee schedules, the payment for a fusion procedure is higher than of an isolated decompression. It has been recently suggested in the lay press that the greater reimbursement for a lumbar arthrodesis may inappropriately influence the manner in which surgeons elect to treat lumbar degenerative conditions, resulting in what they believe to be a substantial number of unnecessary spinal fusions.
A consecutive series of 50 single-level decompression cases performed by single surgeon were retrospectively analyzed and compared with an equivalent cohort of subjects who underwent single-level decompression and instrumented posterolateral fusion with autogenous iliac crest bone grafting. The operative reports, office charts, and billing records were reviewed to determine the total clinical time invested by the surgeon and the Medicare reimbursement for each surgery.
Relative to the corresponding values of the decompression group, combined decompression and fusion procedures were associated with a longer mean surgical time (134.6 min vs. 47.3 min, P<0.0001), a greater number of postoperative visits (1.0 vs. 3.2, P<0.0001), a higher mean total clinical time expenditure (186.6 min vs. 62.2 min, P<0.0001), and a lower mean dollars received per minute of surgeon time ($12.51 vs. $15.51, P<0.001).
These findings challenge the assertion that spine surgeons have an undue financial incentive to recommend a combined decompression and instrumented fusion procedure over an isolated decompression to patients with symptomatic lumbar degeneration, especially when considering the greater time, effort, and risk characteristic of this more complex operation.
回顾性病例对照研究/经济分析。
确定单纯腰椎减压术以及减压联合器械融合术所需的治疗时间，以比较每种手术类型根据外科医生的时间投入所获得的相对报销费用。
根据现行医疗保险费用表，融合手术的费用高于单纯减压术。最近，大众媒体暗示，腰椎融合术更高的报销费用可能会不适当地影响外科医生选择治疗腰椎退行性疾病的方式，导致他们认为有大量不必要的脊柱融合手术。
对一位外科医生连续进行的50例单节段减压病例进行回顾性分析，并与一组接受单节段减压并采用自体髂骨植骨进行器械辅助后外侧融合术的同等病例进行比较。查阅手术报告、门诊病历和计费记录，以确定外科医生投入的总临床时间以及每次手术的医疗保险报销费用。
与减压组的相应值相比，减压联合融合手术的平均手术时间更长（134.6分钟对47.3分钟，P<0.0001），术后就诊次数更多（1.0次对3.2次，P<0.0001），平均总临床时间支出更高（186.6分钟对62.2分钟，P<0.0001），且外科医生每投入一分钟所获得的平均金额更低（12.51美元对15.51美元，P<0.001）。
这些发现对以下观点提出了质疑，即脊柱外科医生在向有症状的腰椎退变患者推荐减压联合器械融合手术而非单纯减压手术时存在不当的经济动机，尤其是考虑到这种更复杂手术具有更长的时间、更高的难度和风险。
