Archives of Neurosurgery
Document Type
Original Research - Oncology
Abstract
Background: Inter-surgeon variability is a potential driver of variation in bundled care costs associated with cervical spine surgery.
Objective: This study aims to determine modifiable inter-surgeon factors that predict hospital cost variations associated with anterior cervical discectomy and fusions (ACDF).
Methods: This is a retrospective review of ACDF cases performed at a single institution by 15 surgeons from 2011 to 2017. Univariate analyses and mixed linear regression models were then used with the surgeon as a random effects variable to determine which factors were associated with surgical episode costs and surgical time. Signs and symptoms of cervical myelopathy were collected from clinic notes before and after surgery to determine changes due to surgical intervention.
Results: In this series of 263 ACDF procedures, the average surgical episode direct cost was $16,447±$5,512. Factors associated with significantly increased surgical episode costs include the number of levels (NOL), cage type, length of stay (LOS), surgical time, neuromonitoring, complication occurrence, and unplanned return to the operating room. Factors associated with a significant increase in surgical time include body mass index, NOL, and surgeon experience. Factors associated with improvements in symptomatology included cage type, NOL, surgical time, and neuromonitoring.
Conclusions: The present study examines inter-surgeon methodology variation as a cost driver in patients undergoing ACDF at our institution. Choosing an interbody device and minimizing neuromonitoring may result in cost savings at the expense of potential improvements in patient outcomes.
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Recommended Citation
Porche, Ken; Vaziri, Sasha; Stein, Alan; Awan, Omar; Lucke-Wold, Brandon; Kubilis, Paul S.; Lipori, Paul; Hoh, Daniel J; Polifka, Adam; and Fox, W. Christopher
(2024)
"Using Intersurgeon Variation to Inform Cost-reduction Strategies in Anterior Cervical Discectomy and Fusion (ACDF),"
Archives of Neurosurgery: Vol. 3:
Iss.
1, Article 1.
Available at:
https://www.ansjournal.org/home/vol3/iss1/1