• James S Yoon, Oliver Y Tang, and Michael T Lawton.
• Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Yale School of Medicine, New Haven, Connecticut, USA.
• World Neurosurg. 2019 Sep 1; 129: e791-e802.

Background/ObjectiveSeveral studies have documented improved outcomes at high-volume hospitals for neurosurgery. However, the relationship between neurosurgical volume and costs remains poorly understood.MethodsUsing neurosurgery-specific Diagnosis-Related Groups (DRG) codes, we identified adult neurosurgical admissions in the National Inpatient Sample from 2002 to 2014. We stratified hospitals by annual neurosurgical volume as high-volume (top 20%) or low-volume centers (bottom 80%). We performed survey-weighted regression analyses to examine the impact of case volume on inpatient costs.ResultsA total of 12,129,029 admissions underwent neurosurgery from 2002 to 2014, with 59.6% treated at high-volume hospitals. Patients at high-volume centers were more likely to have private insurance, higher risk of mortality scores, and higher DRG weight procedures than those at low-volume centers (P < 0.001). High-volume hospital admissions were on average 9% or $1791 more expensive than their low-volume counterparts. However, after adjustment for patient, hospital, and case-mix differences, high-volume hospitals were 4.3% less expensive than low-volume centers ($21,825 vs. $22,924; P < 0.01). The southern United States, which had the biggest volume, showed the highest savings (6.5%).ConclusionsHigh-volume hospitals provide more cost-effective neurosurgical care. Centralization of care at high-volume neurosurgical institutions may be a promising strategy to delivering higher-value care, achieving better outcomes at lower costs.Copyright © 2019 Elsevier Inc. All rights reserved.

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