Introduction: Degenerative spine disease affects primarily the elderly, and utilization of spinal fusion has increased the past two decades. Recent data suggests great variability in overall costs of care associated with fusion. However, the additional healthcare costs associated with perioperative complications are unknown. The incidence of major complications and associated costs-of-care following elective fusion are in need of characterization to better understand healthcare economics of spine surgery.
Methods: A weighted sample of 1,526,386 adults undergoing elective lumbar fusion for degenerative indications were identified in the National Inpatient Sample (2002-2014) using diagnostic and procedure codes for twelve categories of major complications, and patient/hospital variables were evaluated as predictors of the overall reimbursed cost. Mean differences (B) and 95% confidence intervals [95% CI] are reported.
Results: Nineteen percent of patients experienced one or more complications. After adjusting for inflation, the mean overall cost was $32802 ± 19557 showing significant variation for each of the 12 complications, as well as by surgical approach, number of levels fused, and patient/hospital characteristics. Rates of most frequent complications and their adjusted cost-of-care were acute blood loss anemia (11.2%, B=$1817 [$1722-$1913], p<0.001), renal/urinary (1.9%, B=$510 [$288-$732], p<0.001), pulmonary (1.8%, B=$6014 [$5785-6243], p<0.001) and gastrointestinal (1.8%, B=$3699 [$3490-$3908, p<0.001). The costliest events were infection (B=$15882 [$15424-$16339], p<0.001), thromboembolism (B=$8856 [$8400-$9311], p<0.001), hematoma/vascular/seroma (B=$8050 [$7784-$8316], p<0.001).
Conclusions: Inpatient complications following elective lumbar fusion are associated with increased overall cost of hospitalization after adjusting for patient and hospital factors. The magnitude of economic impact associated with perioperative complications may help guide optimization of postoperative recovery and decrease healthcare expenditure.
Patient Care: While elective lumbar fusion improves the quality-of-life and mobility in selective patients, there exists the need to understand the economic impact of inpatient complications that contribute to rising in-hospital costs in an expensive healthcare climate. Targeted quality measures and evidence-based strategies hold promise to not only optimize postoperative recovery but also to decrease overall healthcare spending.
Learning Objectives: By the conclusion of the session, participants should be able to:
1) Describe the overall trends in complication rates and hospital costs associated with elective lumbar fusion in United States from 2002 to 2014.
2) Determine the most common and the costliest complications associated with lumbar fusion, and the risk factors that may predispose surgical patients to experience these inpatient events.
3) Discuss the potential preventive strategies to identify patients at risk during perioperative evaluation, optimize postoperative recovery, and reduce overall healthcare spending.