Lau Darryl, Chan Andrew K, Theologis Alexander A, Chou Dean, Mummaneni Praveen V, Burch Shane, Berven Sigurd, Deviren Vedat, Ames Christopher
Departments of 1 Neurological Surgery and.
Orthopaedic Surgery, University of California, San Francisco, California.
J Neurosurg Spine. 2016 Sep;25(3):366-78. doi: 10.3171/2016.2.SPINE15954. Epub 2016 Apr 29.
OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.
目的 由于原发性和转移性脊柱肿瘤的手术策略不同，与之相关的各自治疗成本和发病率可能存在差异。本研究比较了硬膜外转移性和原发性脊柱肿瘤切除术后的直接成本和90天再入院率。确定了与成本和再入院相关的因素。方法 纳入2008年至2013年间接受脊柱肿瘤切除术的成年人（年龄18岁及以上）。排除硬膜内肿瘤患者。评估初次住院和90天再入院住院的直接成本。比较接受原发性和转移性脊柱肿瘤手术治疗患者的直接成本。采用多变量分析确定与成本和再入院相关的独立因素。结果 共纳入181例脊柱肿瘤患者（63例原发性肿瘤和118例转移性肿瘤）。总体而言，脊柱肿瘤手术治疗的平均初次住院费用为52,083美元。原发性肿瘤（55,801美元）和转移性肿瘤（50,098美元）的住院费用无显著差异（p = 0.426）。与较高成本相关的独立因素为男性（p = 0.032）、术前无法行走（p = 0.002）、合并症超过3种（p = 0.037）、行椎体次全切除术（p = 0.021）、内固定超过7节段（p < 0.001）、前后联合入路（p < 0.001）、存在围手术期并发症（p < 0.001）和住院时间较长（p < 0.001）。围手术期并发症发生率为21.0%。在该队列中，11.6%的患者在90天内再次入院，该再入院的平均住院费用为20,078美元。原发性和转移性肿瘤手术治疗后的再入院率相似（分别为11.1%和11.9%）（p = 0.880）。既往住院时间超过15天（OR 6.62，p = 0.016）和肺转移诊断（OR 52.99，p = 0.007）是再入院的独立预测因素。结论 原发性和转移性脊柱肿瘤在初次手术住院的直接成本和90天内再入院率方面具有可比性。与成本独立相关的因素与术前健康状况、手术类型和复杂性以及术后病程有关。
