The Albert Einstein College of Medicine, Bronx, NY, USA.
Spine (Phila Pa 1976). 2011 May 15;36(11):905-9. doi: 10.1097/BRS.0b013e3181e6c4d8.
This retrospective study assessed the total hospital charges for performing 102 single-level anterior cervical discectomy/fusion (1-ADF) procedures performed during a single year at one institution. All cases were in a single diagnosis-related group (DRG) category (473: cervical spine fusion), and used a single Principle Procedure Code (81.02).
To examine the variations in total hospital charges and to determine the extent to which surgeons affected these charges.
Little is known about the variability in total hospital charges for performing 1-ADF, and how the surgeon affects these charges.
In 2008, 15 surgeons performed 102 1-ADF without comorbidities at a single institution. A total of 80 patients exhibited no myelopathy (ICD-9: 722.0), while 22 were myelopathic (ICD-9-CM: 722.71). The total hospital charges (total charges) were divided into in-patient hospital charges (e.g., room charge/length of stay [LOS], diagnostic studies), and surgical charges. Surgical charges were subdivided into operative charges (operating room, anesthesia, recovery room charges), instrumentation charges (plates/screws, spacers/implants), and supply charges (bone graft supplements). In addition, the total hospital charges were analyzed for the 6 surgeons doing 8 or more cases.
The total hospital charges per patient ranged from $26,653 to $129,220 (a factor of 4.8). The in-patient hospital charges, which ranged from $15,113 to $76,687 (a factor of 5.0), were largely influenced by differing LOS (1-11 days). There was also a large variation in surgical charges, which was largely attributable to the surgeon's choice of instrumentation. Instrumentation charges per patient ranged from $4062 to $40,409 (a factor of 10). The average in-patient hospital and surgical charges of 1 of the 6 surgeons clearly exceeded the averages for the others.
Both the surgeon's choice of instrumentation and the choice of surgeons contributed to large- variations in total hospital charges for 102 patients undergoing 1-ADF.
本回顾性研究评估了在一个机构的一年内进行的 102 例单节段前路颈椎间盘切除术/融合术（1-ADF）的总住院费用。所有病例均在单一诊断相关组（DRG）类别（473：颈椎融合术）中，使用单一主要手术代码（81.02）。
检查总住院费用的变化，并确定外科医生对这些费用的影响程度。
对于进行 1-ADF 的总住院费用的变化以及外科医生如何影响这些费用，知之甚少。
2008 年，15 名外科医生在一个机构中无合并症地进行了 102 例 1-ADF。共有 80 名患者无脊髓病（ICD-9：722.0），22 名患者患有脊髓病（ICD-9-CM：722.71）。总住院费用（总费用）分为住院费用（例如，病房费用/住院时间 [LOS]，诊断研究）和手术费用。手术费用分为手术费用（手术室、麻醉、恢复室费用）、器械费用（钢板/螺钉、间隔物/植入物）和供应费用（骨移植补充剂）。此外，还分析了进行 8 例或更多病例的 6 名外科医生的总住院费用。
每位患者的总住院费用从 26653 美元到 129220 美元不等（相差 4.8 倍）。住院费用从 15113 美元到 76687 美元不等（相差 5 倍），主要受住院时间长短（1-11 天）的影响。手术费用也存在很大差异，主要归因于外科医生对器械的选择。每位患者的器械费用从 4062 美元到 40409 美元不等（相差 10 倍）。6 名外科医生中的 1 名的平均住院和手术费用明显高于其他外科医生的平均值。
外科医生对器械的选择以及外科医生的选择都会导致 102 例接受 1-ADF 治疗的患者的总住院费用发生较大变化。
