Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity

Abstract BACKGROUND Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity. OBJECTIVE To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery. METHODS The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses. RESULTS The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05). CONCLUSION The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.

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313. Risk factors for increased length of stay, reoperation and readmission following adult spinal deformity surgery in the elderly

The Spine Journal ◽

10.1016/j.spinee.2019.05.330 ◽

2019 ◽

Vol 19 (9) ◽

pp. S152

Author(s):

Paramjit Singh ◽

John Ibrahim ◽

Deeptee Jain ◽

Paul Eichenseer ◽

Mayur Kardile ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

The Elderly ◽

Spinal Deformity Surgery ◽

Surgery In The Elderly

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Percutaneous Iliac Screws for Minimally Invasive Spinal Deformity Surgery

Minimally Invasive Surgery ◽

10.1155/2012/173685 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Michael Y. Wang

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Intraoperative Complications ◽

Ct Scanning ◽

Iliac Screws ◽

Fusion Site ◽

Spinal Deformity Surgery ◽

The Mean

Introduction. Adult spinal deformity (ASD) surgeries carry significant morbidity, and this has led many surgeons to apply minimally invasive surgery (MIS) techniques to reduce the blood loss, infections, and other peri-operative complications. A spectrum of techniques for MIS correction of ASD has thus evolved, most recently the application of percutaneous iliac screws.Methods. Over an 18 months 10 patients with thoracolumbar scoliosis underwent MIS surgery. The mean age was 73 years (70% females). Patients were treated with multi-level facet osteotomies and interbody fusion using expandable cages followed by percutaneous screw fixation. Percutaneous iliac screws were placed bilaterally using the obturator outlet view to target the ischial body.Results. All patients were successfully instrumented without conversion to an open technique. Mean operative time was 302 minutes and the mean blood loss was 480 cc, with no intraoperative complications. A total of 20 screws were placed successfully as judged by CT scanning to confirm no bony violations. Complications included: two asymptomatic medial breaches at T10 and L5, and one patient requiring delayed epidural hematoma evacuation.Conclusions. Percutaneous iliac screws can be placed safely in patients with ASD. This MIS technique allows for successful caudal anchoring to stress-shield the sacrum and L5-S1 fusion site in long-segment constructs.

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P88. Extended length of stay after complex adult spinal deformity surgery: predictors and impact on clinical and patient-reported outcomes

The Spine Journal ◽

10.1016/j.spinee.2020.05.486 ◽

2020 ◽

Vol 20 (9) ◽

pp. S189

Author(s):

Jun S. Kim ◽

Nathan J. Lee ◽

Joseph M. Lombardi ◽

Andrew C. Vivas ◽

Scott L. Zuckerman ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Deformity ◽

Patient Reported Outcomes ◽

Adult Spinal Deformity ◽

Patient Reported ◽

Extended Length ◽

Spinal Deformity Surgery

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Surgical Factors and Treatment Severity for Perioperative Complications Predict Hospital Length of Stay in Adult Spinal Deformity Surgery

Spine ◽

10.1097/brs.0000000000004122 ◽

2021 ◽

Vol 47 (2) ◽

pp. 136-143

Author(s):

Hai V. Le ◽

Joseph B. Wick ◽

Renaud Lafage ◽

Michael P. Kelly ◽

Han Jo Kim ◽

...

Keyword(s):

Length Of Stay ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Spinal Deformity Surgery

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Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

Journal of Neurosurgery Spine ◽

10.3171/2019.9.spine19814 ◽

2020 ◽

Vol 32 (3) ◽

pp. 423-431 ◽

Cited By ~ 3

Author(s):

Hiroki Ushirozako ◽

Go Yoshida ◽

Tomohiko Hasegawa ◽

Yu Yamato ◽

Tatsuya Yasuda ◽

...

Keyword(s):

Spinal Deformity ◽

False Positive ◽

Adult Spinal Deformity ◽

False Positive Rate ◽

Multivariate Logistic Regression Analysis ◽

Motor Evoked Potential ◽

Scoliosis Surgery ◽

True Negative ◽

Duration Of Surgery ◽

Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

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