Halperin Scott J, Dhodapkar Meera M, Gouzoulis Michael, Laurans Maxwell, Varthi Arya, Grauer Jonathan N
From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Halperin, Dhodapkar, Gouzoulis, Varthi, and Grauer) and the Department of Neurosurgery, Yale School of Medicine, New Haven, CT (Laurans).
J Am Acad Orthop Surg. 2024 Mar 15;32(6):265-270. doi: 10.5435/JAAOS-D-23-00365. Epub 2023 Dec 7.
Lumbar laminotomy/diskectomy is a common procedure performed to address radiculopathy that persists despite conservative treatment. Understanding cost/reimbursement variability and its drivers has the potential to help optimize related healthcare delivery. The goal of this study was to assess variability and factors associated with reimbursement through 90 days after single-level lumbar laminotomy/diskectomy.
Lumbar laminotomies/diskectomies were isolated from the 2010 to 2021 PearlDiver M151 data set. Exclusion criteria included patients younger than 18 years; other concomitant spinal procedures; and indications of trauma, oncologic, or infectious diagnoses. Patient, surgical, and perioperative data were abstracted. These variables were examined using a multivariable linear regression model with Bonferroni correction to determine factors independently correlated with reimbursement.
A total of 28,621 laminotomies/diskectomies were identified. The average ± standard deviation 90-day postoperative reimbursement was $9,453.83 ± 19,343.99 and, with a non-normal distribution, the median (inner quartile range) was $3,314 ($5,460). By multivariable linear regression, variables associated with greatest increase in 90-day postoperative reimbursement were associated with admission (with the index procedure [+$11,757.31] or readmission [+$31,248.80]), followed by insurance type (relative to Medicare, commercial +$4,183.79), postoperative adverse events (+$2,006.60), and postoperative emergency department visits (+$1,686.89) ( P < 0.0001 for each). Lesser associations were with Elixhauser Comorbidity Index (+$286.67 for each point increase) and age (-$24.65 with each year increase) ( P < 0.001 and P = 0.003, respectively).
This study assessed a large cohort of lumbar laminotomies/diskectomies and found substantial variations in reimbursement/cost to the healthcare system. The largest increase in reimbursement was associated with admission (with the index procedure or readmission), followed by insurance type, postoperative adverse events, and postoperative emergency department visits. These results highlight the need to balance inpatient versus outpatient surgeries while limiting postoperative readmissions to minimize the costs associated with healthcare delivery.
腰椎板切开术/椎间盘切除术是一种常见的手术，用于治疗尽管经过保守治疗仍持续存在的神经根病。了解成本/报销的变异性及其驱动因素有助于优化相关医疗服务的提供。本研究的目的是评估单节段腰椎板切开术/椎间盘切除术后90天内报销的变异性及相关因素。
从2010年至2021年的PearlDiver M151数据集中提取腰椎板切开术/椎间盘切除术的数据。排除标准包括年龄小于18岁的患者；其他同时进行的脊柱手术；以及创伤、肿瘤或感染性诊断的指征。提取患者、手术和围手术期数据。使用带有Bonferroni校正的多变量线性回归模型对这些变量进行分析，以确定与报销独立相关的因素。
共识别出28,621例腰椎板切开术/椎间盘切除术。术后90天报销的平均±标准差为9,453.83美元±19,343.99美元，由于分布不呈正态，中位数（四分位间距）为3,314美元（5,460美元）。通过多变量线性回归分析，术后90天报销增加最多的相关变量与入院（初次手术[增加11,757.31美元]或再次入院[增加31,248.80美元]）相关，其次是保险类型（相对于医疗保险，商业保险增加4,183.79美元）、术后不良事件（增加2,006.60美元）和术后急诊就诊（增加1,686.89美元）（每项P<0.0001）。关联较小的因素包括埃利克斯豪泽合并症指数（每增加一分增加286.67美元）和年龄（每年增加一岁减少24.65美元）（分别为P<0.001和P = 0.003）。
本研究评估了大量腰椎板切开术/椎间盘切除术病例，发现医疗系统的报销/成本存在显著差异。报销增加最多的因素与入院（初次手术或再次入院）相关，其次是保险类型、术后不良事件和术后急诊就诊。这些结果凸显了在平衡住院手术和门诊手术的同时，限制术后再次入院以尽量降低医疗服务相关成本的必要性。
