Diefenbach Christopher, Ialenti Marc N, Lonner Baron S, Kamerlink Jonathan R, Verma Kushagra, Errico Thomas J
Bull Hosp Jt Dis (2013). 2013;71(4):272-7.
A retrospective review of 74 consecutive, surgical patients with neuromuscular scoliosis (NMS).
This study evaluates the distribution of hospital and operating room costs incurred during surgical correction of NMS.
Recent studies have demonstrated that surgical treatment improves both medical outcomes and the quality of life in patients with progressive NMS. Characterization of the costs incurred at the time of surgery and hospitalization will facilitate the identification of opportunities for cost reduction.
Demographic data collected included gender, age, preoperative height, weight, and BMI. Major coronal curvatures and T5-T12 kyphosis were assessed from radiographs. Construct type and number of screws, hooks, and wires implanted were recorded. Surgical costs were calculated based on cost of surgical correction, hospital stay, and postoperative care.
Mean age was 15.8 ± 7.3 years; 57% were male. Comorbidities included cerebral palsy (28%) and familial dysautonomia (14%). The mean preoperative major curve magnitude was 60°; minor curve magnitude was 33°. Posterior approach (76%) and pedicle screws (75%) were predominantly utilized. The average length of hospitalization was 8 days (range: 3 to 47). There were six major complications (8%). The total surgical cost was $50,096 ± $23,998. The highest individual cost was for implants ($13,916; 24% of total costs). The second highest was inpatient room and ICU costs ($12,483; 22%); bone grafts were the third ($6,398; 11%). Increased major and minor structural curve, increased total (A/P) levels fused, and increased length of hospital stay predicted an increase in total cost.
Major contributors to cost in NMS surgery are implants, inpatient room and ICU costs, and bone grafts. Independent predictors of higher cost are the degree of major and minor structural curve, total number of A/P levels fused, and length of hospital stay. These conclusions provide insight into costs associated with care for a medically fragile and challenging patient population.
对74例连续性手术治疗的神经肌肉型脊柱侧弯（NMS）患者进行回顾性研究。
本研究评估手术矫正NMS期间的医院和手术室费用分布情况。
近期研究表明，手术治疗可改善进行性NMS患者的医疗结局和生活质量。明确手术和住院期间的费用情况将有助于找出降低成本的机会。
收集的人口统计学数据包括性别、年龄、术前身高、体重和体重指数。从X线片评估主要冠状面弯曲度和T5 - T12后凸畸形。记录植入的内固定类型以及螺钉、钩和钢丝的数量。手术费用根据手术矫正成本、住院时间和术后护理费用计算得出。
平均年龄为15.8±7.3岁；57%为男性。合并症包括脑瘫（28%）和家族性自主神经功能异常（14%）。术前主要弯曲度平均为60°；次要弯曲度为33°。主要采用后路手术（76%）和椎弓根螺钉（75%）。平均住院时间为8天（范围：3至47天）。有6例严重并发症（8%）。手术总费用为50,096美元±23,998美元。单项费用最高的是植入物（13,916美元；占总费用的24%）。第二高的是住院病房和重症监护病房费用（12,483美元；占22%）；骨移植排第三（6,398美元；占11%）。主要和次要结构弯曲度增加、融合的总（前后）节段数增加以及住院时间延长预示着总费用增加。
NMS手术费用的主要构成部分是植入物、住院病房和重症监护病房费用以及骨移植。费用较高的独立预测因素是主要和次要结构弯曲度、融合的A/P节段总数以及住院时间。这些结论为了解这类医疗脆弱且具有挑战性的患者群体的护理相关费用提供了见解。
