Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbia, Ohio, USA.
Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbia, Ohio, USA.
World Neurosurg. 2019 Oct;130:e535-e541. doi: 10.1016/j.wneu.2019.06.149. Epub 2019 Jul 4.
To understand cost distribution in a 90-day episode of care following posterior spinal fusions (PSFs) for adolescent idiopathic scoliosis (AIS).
The 2007-2016 Humana PearlDiver dataset was queried using Current Procedural Terminology codes (22800, 22802, 22804, 22842, 22843, and 22844) to identify patients with AIS, aged 10-19 years, receiving PSFs. The following categories were used to define distribution in 90-day costs: 1) facility costs, 2) surgeon costs, 3) anesthesia costs, 4) intraoperative neuromonitoring, 5) hospital services and investigations, 6) intensive care unit stay, 7) radiology, 8) physical therapy/rehabilitation, 9) office visits, and 10) readmissions.
A total of 455 patients with AIS received PSFs, of whom 381 (83.7%) were commercial insurance beneficiaries and 74 (16.3%) were Medicaid beneficiaries. The overall average 90-day cost of surgery was $124,360 with the 90-day stipulated bundled prices being $136,302 and $62,871 for commercial and Medicaid beneficiaries, respectively. Facility costs comprised 85%-92% of the 90-day cost, followed by surgeon costs (5.2%-5.7%). Post-acute care (physical therapy/rehab and office visits) was not a major driver of the 90-day cost (0.2%-0.3%). Significant independent predictors of increased 90-day costs were-increased co-morbidity burden (+$11,284), ≥7 levels fusion (+$65,330), and length of stay (+$5298/day). Medicaid (-$81,957) payer type was associated with lower 90-day costs.
Facility costs are a major determinant of overall 90-day costs following PSFs in AIS. Providers should aim at optimizing the co-morbidity burden and constructing accelerated care-pathways to decrease the length of stay and reduce the cost of the entire episode of care.
了解青少年特发性脊柱侧凸（AIS）后路脊柱融合术后 90 天治疗期间的成本分布。
使用当前程序术语（22800、22802、22804、22842、22843 和 22844）查询 2007-2016 年 Humana PearlDiver 数据集，以确定患有 AIS 的患者，年龄在 10-19 岁之间，接受后路脊柱融合术。以下类别用于定义 90 天成本的分布：1）设施成本，2）外科医生成本，3）麻醉成本，4）术中神经监测，5）医院服务和调查，6）重症监护病房住院，7）放射学，8）物理治疗/康复，9）门诊就诊，10）再入院。
共有 455 名患有 AIS 的患者接受了后路脊柱融合术，其中 381 名（83.7%）为商业保险受益人，74 名（16.3%）为医疗补助受益人。手术总平均 90 天费用为 124360 美元，90 天规定捆绑价格分别为商业受益人和医疗补助受益人的 136302 美元和 62871 美元。设施成本占 90 天成本的 85%-92%，其次是外科医生成本（5.2%-5.7%）。急性后期护理（物理治疗/康复和门诊就诊）不是 90 天成本的主要驱动因素（0.2%-0.3%）。增加 90 天费用的显著独立预测因素为-合并症负担增加（+11284 美元）、≥7 级融合（+65330 美元）和住院时间延长（+5298 美元/天）。医疗补助（-81957 美元）支付类型与较低的 90 天费用相关。
设施成本是 AIS 后路脊柱融合术后整体 90 天成本的主要决定因素。提供者应旨在优化合并症负担，并构建加速护理途径，以缩短住院时间并降低整个治疗期间的成本。
