Introduction: There is limited understanding of what underlies the variability in cost for spinal fusions across institutions and geographic regions. While many studies have focused on total hospital costs, few examine the cost of supplies used in the operating room. The goal of this study is to evaluate the effect of patient, procedural, and provider factors on ACDF surgical supply costs, and to determine if these costs are associated with patient outcomes.
Methods: Retrospective review of 101 patients who underwent 1-4 level ACDF at 1 institution from 2013-2014. Outcomes were surgical supply costs, length of stay, discharge status, Neck Disability Index (NDI) and EQ-5D at 3 months post-op, pseudarthrosis requiring posterior fusion at 1 year post-op, length of stay, discharge status, and 30-day readmission. Predictor variables included patient age, gender, BMI, medical history (# medications, comorbidities, ASA class), insurance status, operative time, and provider.
Results: The average surgical supply costs are $3,981±983, $5,685±1,222, $7,533±1,618, and $9,176±576 for 1, 2, 3, and 4-level ACDF respectively. Univariate analyses reveal that patient age, pre-operative NDI, # operated levels, and procedure length are associated with surgical supply cost per operated level. Multivariate analyses show that age, # operated levels, and provider are the three strongest predictors of surgical supply cost per operated level (p<0.01). There is no association between surgical supply cost per level and improvement in NDI or EQ-5D at 3 months post-op, probability of pseudarthrosis requiring fusion at 1 year post-op, discharge status, or 30-day readmission.
Conclusions: The most important predictors of surgical supply cost in ACDF include an intrinsic patient factor (age), a procedural variable (# operated levels), and provider-specific factors. It is of utmost importance that cost-effectiveness and cost comparison studies adequately control for these differences.
Patient Care: Anecdotally, surgeons use different spinal implants and supplies for various reasons, including personal preference, but there is often little understanding of how these supply choices affect outcomes. The goal of our research is to better understand what factors affect surgical supply cost, specifically in ACDFs, and whether surgical supply cost is associated with different patient outcomes. This type of research is necessary so that we can better understand why ACDF costs vary so much between providers and institutions, and how we can provide more cost-effective care to a greater number of patients in our country.
Learning Objectives: By conclusion of this session, participants should be able to:
1) Identify the patient, procedural, and provider-specific factors that are associated with ACDF surgical supply cost at our institution
2) Describe the association between ACDF supply cost and patient outcomes in our patient cohort
3) Discuss the various factors that underlie ACDF supply choice at their own institution and how these may affect total costs and patient outcomes