Koo Andrew B, Elsamadicy Aladine A, Sarkozy Margot, Pathak Neil, David Wyatt B, Freedman Isaac G, Reeves Benjamin C, Sciubba Daniel M, Laurans Maxwell, Kolb Luis
Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, United States.
N Am Spine Soc J. 2022 Jan 6;9:100099. doi: 10.1016/j.xnsj.2022.100099. eCollection 2022 Mar.
As health care expenditures continue to increase, standardizing health care delivery across geographic regions has been identified as a method to reduce costs. However, few studies have demonstrated how the practice of elective spine surgery varies by geographic location. The aim of this study was to assess the geographic variations in management, complications, and total cost of elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).
The National Inpatient Sample database (2016-2017) was queried using the ICD-10-CM procedural and diagnostic coding systems to identify all adult (≥18 years) patients with a primary diagnosis of CSM undergoing an elective ACDF. Patients were divided into regional cohorts as defined by the U.S. Census Bureau: Northeast, Midwest, South, and West. Weighted patient demographics, Elixhauser comorbidities, perioperative complications, length of stay (LOS), discharge disposition, and total cost of admission were assessed.
A total of 17,385 adult patients were identified. While the age (p=0.116) and proportion of female patients (p=0.447) were similar among the cohorts, race (p<0.001) and healthcare coverage (p<0.001) varied significantly. The Northeast had the largest proportion of patients in the 76-100th household income quartile (Northeast: 32.1%; Midwest: 16.9%; South: 15.7%; West: 27.5%, p<0.001). Complication rates were similar between regional cohorts (Northeast: 10.1%; Midwest: 12.2%; South: 10.3%; West: 11.9%, p=0.503), as was LOS (Northeast: 2.2±2.4 days; Midwest: 2.1±2.4 days; South: 2.0±2.5 days; West: 2.1±2.4 days, p=0.678). The West incurred the greatest mean total cost of admission (Northeast: $19,167±10,267; Midwest: $18,903±9,114; South: $18,566±10,152; West: $24,322±15,126, p<0.001). The Northeast had the lowest proportion of patients with a routine discharge (Northeast: 72.0%; Midwest: 84.8%; South: 82.3%; West: 83.3%, p<0.001). The odds ratio for Western hospital region was 3.46 [] compared to the Northeast for increased cost.
Our study suggests that regional variations exist in elective ACDF for CSM, including patient demographics, hospital costs, and nonroutine discharges, while complication rates and LOS were similar between regions.
随着医疗保健支出持续增加，跨地理区域规范医疗服务已被视为降低成本的一种方法。然而，很少有研究表明择期脊柱手术的实践如何因地理位置而异。本研究的目的是评估颈椎脊髓病（CSM）择期前路颈椎间盘切除融合术（ACDF）在管理、并发症及总费用方面的地理差异。
使用ICD - 10 - CM程序和诊断编码系统查询国家住院样本数据库（2016 - 2017年），以识别所有主要诊断为CSM并接受择期ACDF的成年（≥18岁）患者。患者按照美国人口普查局定义分为区域队列：东北部、中西部、南部和西部。评估加权患者人口统计学、埃利克斯豪泽合并症、围手术期并发症、住院时间（LOS）、出院处置及入院总费用。
共识别出17385例成年患者。虽然各队列间年龄（p = 0.116）和女性患者比例（p = 0.447）相似，但种族（p < 0.001）和医保覆盖情况（p < 0.001）差异显著。东北部处于家庭收入四分位数第76 - 100位的患者比例最高（东北部：32.1%；中西部：16.9%；南部：15.7%；西部：27.5%，p < 0.001）。区域队列间并发症发生率相似（东北部：10.1%；中西部：12.2%；南部：10.3%；西部：11.9%，p = 0.503），住院时间也相似（东北部：2.2±2.4天；中西部：2.1±2.4天；南部：2.0±2.5天；西部：2.1±2.4天，p = 0.678）。西部的平均入院总费用最高（东北部：19167美元±10267美元；中西部：18903美元±9114美元；南部：18566美元±10152美元；西部：24322美元±15126美元，p < 0.001）。东北部常规出院患者比例最低（东北部：72.0%；中西部：84.8%；南部：82.3%；西部：83.3%，p < 0.001）。与东北部相比，西部医院区域费用增加的优势比为3.46 []。
我们的研究表明，CSM择期ACDF存在区域差异，包括患者人口统计学、医院费用和非常规出院情况，而各区域间并发症发生率和住院时间相似。
