• World Neurosurg · Jun 2020

    Pre-Operative and Post-Operative Spending Among Working Age Adults Undergoing Posterior Spinal Fusion Surgery for Degenerative Pathology.

    • Majd Marrache, Andrew B Harris, Micheal Raad, Varun Puvanesarajah, Jina Pakpoor, Mark C Bicket, Hamid Hassanzadeh, and Amit Jain.
    • Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.
    • World Neurosurg. 2020 Jun 1; 138: e930-e939.

    ObjectiveTo investigate the health care resource utilization and the associated 6 months preoperative and 6 months postoperative spending among patients undergoing posterior lumbar fusion.MethodsWe retrospectively reviewed a private insurance claims database for patients who underwent single-level posterior spinal fusion from January 2011 to December 2015. Outpatient health services, prescription pain medications, and inpatient admissions were assessed.ResultsAmong 25,401 patients (mean age, 52 years; 58% female) in the final cohort, median spending during the period from 6 months before surgery to 6 months after surgery was $60,714 (interquartile range [IQR], $46,961-$79,892)/patient. Preoperative spending accounted for 7% ($121 million) of the total costs, and postoperative spending accounted for 8% ($135 million). Median preoperative spending was $3566 (IQR, $2144-$5857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. In the 6 months period preceding surgery, 46% patients received injections and 47% received physical therapy. The median postoperative spending was $1954/patient (IQR, $735-$4416). Total postoperative spending was significantly higher among those not discharged home (median, $7525; IQR, $6779-$19,602) compared with those discharged home (median, $1617/patient; IQR, $648-$4033) and home with home care services (median, $2921; IQR, $1406-$5662) (P < 0.001).ConclusionsUnplanned readmission after posterior spinal fusion was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the preoperative and postoperative period in patients undergoing single-level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost containment.Copyright © 2020 Elsevier Inc. All rights reserved.

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