Virk Sohrab, Phillips Frank M, Khan Safdar
Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
Int J Spine Surg. 2017 Aug 1;11(4):25. doi: 10.14444/4025. eCollection 2017.
To assess patterns of healthcare resource utilization prior to anterior cervical decompression and fusion (ACDF) in patients diagnosed with radiculopathy with a retrospective cohort study design.
ACDF is associated with improvement in quality of life among patients with cervical radiculopathy. However, little is known regarding utilization of healthcare services and total cost of care before ACDF surgery in the United States.
We analyzed a group of patients who received ACDF for radiculopathy during 2009-2011 using a healthcare database of over 20 million patients of all ages. Patients with fewer than two years of data prior to ACDF procedure were excluded. Inclusion criteria included patients with a diagnosis of disc displacement/degeneration and radiculopathy. All charges related to healthcare administration within two years prior to surgery were recorded and analyzed.
Sixteen hundred seventy six patients met the inclusion criteria. Seventy-three percent of patients were in the 40-59 year age range; 55% were women and 45% were men. In the two years preceding the surgery, 34% of patients received prescription NSAIDs, and 98% received prescription narcotics for total charges of $101,188 ($174.46/patient) and $222,860 ($134.82/patient) respectively. Total pain-related interventions over two years (oral pharmacotherapy and injections) were charged at $4,368,900 at an average of $2,606/treatment. Total outpatient charges including physician office visits, other outpatient visits and emergency room visits amounted to $25,450,012. Mean total outpatient charges over the two years preceding ACDF was $15,556 per patient for 26,397 episodes of care. Injectable corticosteroids were provided for 84.7% of patients and charges related to this treatment totaled $1,137 per patient.
In the two years prior to ACDF, healthcare resource utilization is extremely high. Given that these patients ultimately undergo surgical intervention, opportunities to reduce charges of conservative care exist.
采用回顾性队列研究设计，评估诊断为神经根病的患者在颈椎前路减压融合术（ACDF）之前的医疗资源利用模式。
ACDF与颈椎神经根病患者生活质量的改善相关。然而，在美国，关于ACDF手术前医疗服务的利用情况和护理总成本知之甚少。
我们使用一个包含超过2000万各年龄段患者的医疗数据库，分析了一组在2009年至2011年期间因神经根病接受ACDF的患者。排除了在ACDF手术前数据少于两年的患者。纳入标准包括诊断为椎间盘移位/退变和神经根病的患者。记录并分析了手术前两年内与医疗管理相关的所有费用。
1676名患者符合纳入标准。73%的患者年龄在40至59岁之间；55%为女性，45%为男性。在手术前两年，34%的患者接受了处方非甾体抗炎药治疗，98%的患者接受了处方麻醉药品治疗，总费用分别为101,188美元（每位患者174.46美元）和222,860美元（每位患者134.82美元）。两年内与疼痛相关的总干预措施（口服药物治疗和注射）费用为4,368,900美元，平均每次治疗2,606美元。包括医生门诊、其他门诊就诊和急诊就诊在内的门诊总费用为25,450,012美元。在ACDF手术前两年，每位患者的门诊平均总费用为15,556美元，共26,397次就诊。84.7%的患者接受了注射用皮质类固醇治疗，与此治疗相关的费用每位患者总计1,137美元。
在ACDF手术前两年，医疗资源利用率极高。鉴于这些患者最终接受了手术干预，存在降低保守治疗费用的机会。
