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  • Cervical Spondylotic Myelopathy and its Association with Increased Healthcare Cost and Utilization After Surgery

    Final Number:

    Clifford Crutcher MD; Gina Corsaletti; Sarah Travers; Jessica Shields PhD; Erin Fannin BA, MS; Jason D. Wilson MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Cervical spondylotic myelopathy (CSM) is often a progressive, debilitating neurological condition, resulting from compression of the spinal cord. 2 Surgical decompression and fusion is safe and associated with improved neurological function postoperatively for select patients. 1 Recent trends in hospitalizations and healthcare cost and utilization for CSM are lacking.

    Methods: We retrospectively reviewed all hospital encounters for ICD-9-CM principal diagnosis code 721.1, which codes for cervical spondylotic myelopathy. Of those patients, 91 patients underwent surgery and met inclusion criteria. Nurick grade was used to assess disease severity. Age, sex, race, body mass index (BMI), and Nurick grade were evaluated in their relation to hospital length of stay (LOS) and discharge disposition. We assumed that patients requiring longer hospital stays and discharge to inpatient rehab utilized greater healthcare resources than their counterparts. Data was analyzed using SPSS statistical analysis software.

    Results: The average patient was 52.1. Increased Nurick grade was associated with increased hospital length of stay (p <0.001). The average LOS for Nurick grade 1 was 2.57 days, while the mean LOS was 11.5 days for Nurick grade 4. Body Mass Index was associated with increased LOS (p= 0.001). Higher Nurick scores were also associated with discharge to inpatient rehab rather than discharge to home (p < 0.05). Age, race, and sex were not associated with increased hospital LOS or discharge to inpatient rehab.

    Conclusions: Our data suggest that patients with higher Nurick scores and worse cervical spondylotic myelopathy had longer hospital stays and were more likely to be discharged to inpatient rehab rather than home. Our data further suggest that Nurick grade 4 cervical spondylotic myelopathy patients are associated with increased healthcare cost and utilization when compared to other CSM patients.

    Patient Care: This research will provide surgeons with data to counsel patients about expected hospital recovery times after surgical decompression for myelopathy.

    Learning Objectives: Examine the association between cervical myelopathy disease severity and increased hospital length of stay.

    References: 1. Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al: Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. The Journal of bone and joint surgery. American volume 95:1651-1658, 2013 2.Karadimas SK, Erwin WM, Ely CG, Dettori JR, Fehlings MG: Pathophysiology and natural history of cervical spondylotic myelopathy. Spine 38:S21-36, 2013

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