Davison Mark A, Lilly Daniel T, Moreno Jessica, Cheng Joseph, Bagley Carlos, Adogwa Owoicho
Rush University Medical Center, Chicago, IL, USA.
University of Texas South Western Medical Center, Dallas, TX, USA.
Global Spine J. 2020 Apr;10(2):138-147. doi: 10.1177/2192568219844227. Epub 2019 Apr 22.
Retrospective cohort study.
To characterize regional variations in maximal nonoperative therapy (MNT) costs in patients suffering from lumbar stenosis or spondylolisthesis.
Medical records from patients with symptomatic lumbar stenosis or spondylolisthesis undergoing primary ≤3-level lumbar decompression and fusion procedures from 2007 to 2016 were gathered from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected the US Census Bureau definitions. Records were searchable by International Classification of Diseases diagnosis/procedure codes, Current Procedural Terminology codes, and insurance-specific generic drug codes. Utilization of MNT, defined as cost billed, prescriptions written, and number of units disbursed, within 2-years prior to index surgery was assessed.
A total of 27 877 patients underwent 1-, 2-, or 3-level lumbar decompression and fusion surgery. Regional breakdown of the study cohort was as follows: South 62.3%, Midwest 25.2%, West 10.4%, Northeast 2.1%. Regional variations in the number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) ( < .0001), opioids ( < .0001), muscle relaxants ( < .0001), and lumbar steroid injections ( < .0001) were detected. A significant difference was identified in the regional MNT failure rates ( < .0001). The total cost associated with MNT prior to index surgery was $48 411 125 ($1736.60/patient), with the Midwest ($1943.83/patient) responsible for the greatest average spending. Despite comprising 62.3% of the cohort, the South was accountable for 67.5% of NSAID prescriptions, 64.6% of opioid prescriptions, and 71.2% of muscle relaxant prescriptions.
Regional differences exist in the costs of MNT in patients with lumbar stenosis and spondylolisthesis prior to surgery. Future studies should focus on identifying patients likely to fail prolonged nonoperative management.
回顾性队列研究。
描述腰椎管狭窄症或腰椎滑脱症患者最大非手术治疗（MNT）费用的地区差异。
从一个大型保险数据库收集2007年至2016年接受初次≤3节段腰椎减压融合手术的有症状腰椎管狭窄症或腰椎滑脱症患者的病历。地理区域（中西部、东北部、南部和西部）反映了美国人口普查局的定义。记录可通过国际疾病分类诊断/程序代码、现行程序术语代码和特定保险公司的通用药物代码进行检索。评估了索引手术前2年内MNT的使用情况，定义为计费成本、开具的处方和发放的单位数量。
共有27877例患者接受了1、2或3节段腰椎减压融合手术。研究队列的地区分布如下：南部62.3%，中西部25.2%，西部10.4%，东北部2.1%。检测到使用非甾体抗炎药（NSAIDs）（<.0001）、阿片类药物（<.0001）、肌肉松弛剂（<.0001）和腰椎类固醇注射（<.0001）的患者数量存在地区差异。在地区MNT失败率方面发现了显著差异（<.0001）。索引手术前与MNT相关的总成本为48411125美元（每位患者1736.60美元），中西部地区（每位患者1943.83美元）的平均支出最高。尽管南部占队列的62.3%，但南部开出了67.5%的NSAID处方、64.6%的阿片类药物处方和71.2%的肌肉松弛剂处方。
腰椎管狭窄症和腰椎滑脱症患者手术前MNT费用存在地区差异。未来的研究应侧重于识别可能在长期非手术治疗中失败的患者。
