Peterson Asa, Behrens Jonathan, Salari Pooria, Place Howard
Department of Orthopedic Surgery, Center for Specialized Medicine, St. Louis University Hospital, 1225 S Grand Blvd, St. Louis, MO 63104, United States.
N Am Spine Soc J. 2023 Jul 6;15:100242. doi: 10.1016/j.xnsj.2023.100242. eCollection 2023 Sep.
Transverse process fractures (TPF) of the thoracic and lumbar spine have become increasingly identified due to CT imaging. Spine service consultation is common for further evaluation and management. There are several studies that demonstrate no difference in clinical outcome with or without spine service intervention. However, no study to our knowledge provides an additional cost analysis. We hypothesize that isolated thoracolumbar TPF are stable injuries. Furthermore, spine service consultation and evaluation results in increased health care costs.
Patients were identified using trauma registry data at Saint Louis University (SLU) from January 2012 to August 2018. Chart and imaging review was performed to determine if additional spine fractures were identified by the spine team which were not included in the initial radiology report. TPF associated with other spinal injuries were defined as one or more thoracic and/or lumbar TPF in addition to any other acute fracture or dislocation in the cervical, thoracic, or lumbar spine. A separate cost analysis with institution-specific charges was also performed.
Six hundred eighty-two patients with TPF from January 2012 to August 2018 were identified. Two hundred twenty-eight patients met the criteria to be included in this study. Additional spinal pathology that was not included in the initial radiology report was identified in 5 (2.19%) patients, none of which required surgical intervention. Cost analysis demonstrated additional costs associated with spine service intervention totaled $1,725,360.28. Average cost per patient in our cohort summed to $2,529.85.
These data support that isolated TPF of the thoracic and lumbar spine are stable injuries that likely do not require spine service intervention and in fact may represent unnecessary financial burden. Foregoing unnecessary consultation can alleviate time constraints within spine service practices and reduce health care costs by eliminating costly extraneous interventions from the patient's care.
由于CT成像技术的应用，胸腰椎横突骨折（TPF）的诊断率日益提高。脊柱专科会诊常用于进一步评估和治疗。多项研究表明，接受或未接受脊柱专科干预的患者临床结局并无差异。然而，据我们所知，尚无研究进行额外的成本分析。我们推测，单纯的胸腰椎TPF属于稳定性损伤。此外，脊柱专科会诊和评估会导致医疗成本增加。
利用圣路易斯大学（SLU）2012年1月至2018年8月的创伤登记数据确定研究对象。通过查阅病历和影像资料，确定脊柱团队是否发现了最初放射学报告中未包含的其他脊柱骨折。与其他脊柱损伤相关的TPF定义为除颈椎、胸椎或腰椎的任何其他急性骨折或脱位外，还存在一处或多处胸腰椎TPF。同时，还进行了基于机构特定收费的单独成本分析。
确定了2012年1月至2018年8月期间682例TPF患者。228例患者符合纳入本研究的标准。5例（2.19%）患者被发现存在最初放射学报告中未包含的其他脊柱病变，均无需手术干预。成本分析显示，与脊柱专科干预相关的额外费用总计1,725,360.28美元。我们队列中每位患者的平均费用总计2,529.85美元。
这些数据支持，单纯的胸腰椎TPF是稳定性损伤，可能无需脊柱专科干预，实际上可能构成不必要的经济负担。避免不必要的会诊可以缓解脊柱专科的时间压力，并通过消除患者护理中昂贵的额外干预措施来降低医疗成本。
