Zygourakis Corinna C, Liu Caterina Y, Wakam Glenn, Moriates Christopher, Boscardin Christy, Ames Christopher P, Mummaneni Praveen V, Ratliff John, Dudley R Adams, Gonzales Ralph
Department of Neurological Surgery, University of California, San Francisco, California.
Center for Healthcare Value, University of California, San Francisco, California.
Neurosurgery. 2017 Aug 1;81(2):331-340. doi: 10.1093/neuros/nyx047.
Spinal surgery costs vary significantly across hospitals and regions, but there is insufficient understanding of what drives this variation.
To examine the factors underlying the cost variation for lumbar laminectomy/discectomy and lumbar fusions.
We obtained patient information (age, gender, race, severity of illness, risk of mortality, population of county of residence, median zipcode income, insurance status, elective vs nonelective admission, length of stay) and hospital data (region, hospital type, bed size, wage index) for all patients who underwent lumbar laminectomy/discectomy (n = 181 267) or lumbar fusions (n = 433 364) for degenerative conditions in the 2001 to 2013 National Inpatient Sample database. We performed unadjusted and adjusted analyses to determine which factors affect cost.
Mean costs for lumbar laminectomy/discectomy and lumbar fusion increased from $8316 and $21 473 in 2001 (in inflation-adjusted 2013 dollars), to $11 405 and $29 438, respectively, in 2013. There was significant regional variation in cost, with the West being the most expensive region across all years and showing the steepest increase in cost over time. After adjusting for patient and hospital factors, the West was 23% more expensive than the Northeast for lumbar laminectomy/discectomy, and 25% more expensive than the Northeast for lumbar fusion ( P < .01). Higher wage index, smaller hospital bed size, and rural/urban nonteaching hospital type were also associated with higher cost for lumbar laminectomy/discectomy and fusion ( P < .01).
After adjusting for patient factors and wage index, the Western region, hospitals with smaller bed sizes, and rural/urban nonteaching hospitals were associated with higher costs for lumbar laminectomy/discectomy and lumbar fusion.
脊柱手术费用在不同医院和地区差异显著，但对于造成这种差异的原因人们了解不足。
探讨腰椎椎板切除术/椎间盘切除术和腰椎融合术费用差异的潜在因素。
我们从2001年至2013年全国住院患者样本数据库中获取了所有因退行性疾病接受腰椎椎板切除术/椎间盘切除术（n = 181267）或腰椎融合术（n = 433364）患者的信息（年龄、性别、种族、疾病严重程度、死亡风险、居住县人口、邮政编码中位数收入、保险状况、择期与非择期入院、住院时间）以及医院数据（地区、医院类型、床位规模、工资指数）。我们进行了未调整和调整分析，以确定哪些因素会影响费用。
腰椎椎板切除术/椎间盘切除术和腰椎融合术的平均费用从2001年的8316美元和21473美元（按2013年通胀调整后的美元计算），分别增至2013年的11405美元和29438美元。费用存在显著的地区差异，西部地区在所有年份都是费用最高的地区，且随着时间推移费用增长最为显著。在调整患者和医院因素后，腰椎椎板切除术/椎间盘切除术方面，西部地区比东北部地区贵23%，腰椎融合术方面比东北部地区贵25%（P <.01）。较高的工资指数、较小的医院床位规模以及农村/城市非教学医院类型也与腰椎椎板切除术/椎间盘切除术和融合术的较高费用相关（P <.01）。
在调整患者因素和工资指数后，西部地区、床位规模较小的医院以及农村/城市非教学医院与腰椎椎板切除术/椎间盘切除术和腰椎融合术的较高费用相关。
