Alfonzo Horowitz Melanie, Tang Linda, Brown Nolan J, Patel Saarang, Khan Mohammad Faizan, Chakravarti Sachiv, Mirahmadi Eraghi Mohammad, Pennington Zach, Gendreau Julian Lassiter, Elder Benjamin D
Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Orange, United States.
Department of Neurosurgery, University of California, Irvine, Orange, United States.
Surg Neurol Int. 2025 May 2;16:162. doi: 10.25259/SNI_209_2025. eCollection 2025.
As the population continues to age, the number of adults receiving care for hydrocephalus is expected to increase. Here, we assess trends in the utilization and physician reimbursement for ventriculoperitoneal shunts (VPS), lumboperitoneal shunting (LPS), and endoscopic third ventriculostomy (ETV) for adult hydrocephalus.
The Medicare Part B National Summary Data files from 2000 to 2021 were collected, and information was extracted on procedures performed per year, total charges billed, and actual payments. Linear mixed-model regression analyses were conducted to assess the significance of changes in procedural volume and physician reimbursement over time while adjusting for inflation.
Over the period studied, there was a 26% increase in VPS placement ( = 0.11), 11.34% increase in ETV utilization ( < 0.01), and 43.1% decrease in LPS utilization ( < 0.01). This corresponded to annualized changes of + 4.29% for ETV procedures, -8.78% for LPS, and + 45.8% for VPS. There was a statistically significant difference in the change of rate of number of procedures annually between LPS and VPS ( = 0.04). In both inflation-unadjusted and inflation-adjusted analyses, all procedures experienced an annual decline in reimbursement with inflation-adjusted changes of -11.54%/year for ETV, -4.13% for LPS, and -13.12% for VPS. There was a statistically significant difference in the change of rate of reimbursement between LPS procedures and both ETV ( < 0.01) and VPS ( < 0.01).
Medicare reimbursement data shows that a commensurate decline in physician reimbursement has accompanied the ongoing rise in adult hydrocephalus procedures.
随着人口持续老龄化，接受脑积水治疗的成年人数量预计会增加。在此，我们评估成人脑积水的脑室腹腔分流术（VPS）、腰大池腹腔分流术（LPS）和内镜下第三脑室造瘘术（ETV）的使用趋势及医生报销情况。
收集了2000年至2021年医疗保险B部分的全国汇总数据文件，并提取了每年进行的手术、总收费和实际支付的信息。进行线性混合模型回归分析，以评估手术量和医生报销随时间变化的显著性，同时对通货膨胀进行调整。
在研究期间，VPS置入量增加了26%（P = 0.11），ETV使用率增加了11.34%（P < 0.01），LPS使用率下降了43.1%（P < 0.01）。这相当于ETV手术的年化变化率为 + 4.29%，LPS为 - 8.78%，VPS为 + 45.8%。LPS和VPS每年手术数量变化率存在统计学显著差异（P = 0.04）。在未调整通货膨胀和调整通货膨胀的分析中，所有手术的报销费用均逐年下降，ETV调整通货膨胀后的变化率为 - 11.54%/年，LPS为 - 4.13%，VPS为 - 13.12%。LPS手术与ETV（P < 0.01）和VPS（P < 0.01）的报销变化率存在统计学显著差异。
医疗保险报销数据显示，随着成人脑积水手术的持续增加，医生报销费用相应下降。
