P51. Differences in charges for elective single level anterior cervical discectomy and fusion across hospital size: A nationwide readmissions database analysis

Abstract

BACKGROUND CONTEXT Rising health care expenditures in the United States place an imperative on providers, payers, and policymakers to more closely evaluate hospital charges. While previous spine surgery studies have compared charges across procedures and in the presence of comorbidities, the association between charges and hospital size in Anterior Cervical Discectomy and Fusion (ACDF) has yet to be understood. PURPOSE To assess the differences in charges for elective single-level ACDF procedures across hospitals of different size. STUDY DESIGN/SETTING This was a retrospective analysis utilizing elective, single-level ACDF data from January 2016 to September 2016 in the HCUP Nationwide Readmissions Database (NRD). PATIENT SAMPLE A total of 13,776 cases of elective, single-level ACDF were identified. Patients who underwent single-level ACDF were identified using the ICD-10 procedural codes for single-level anterior cervical fusion. Patients who underwent cervical disc arthroplasty were excluded from this study. Additional exclusion criteria were death during hospitalization, nonelective surgery, use of emergency services, and age OUTCOME MEASURES Total charges were compared across hospital sizes (small, medium, and large). METHODS Elective single-level ACDF cases were stratified into three groups by hospital bedsize (small, medium, and large) as classified by the NRD. As per the NRD, about one-third of the hospitals within a specific teaching status, location, and region grouping are assigned to each bedsize category. Mean total charges were compared across hospital size utilizing one-way analysis of variance (ANOVA) and subsequently the post-hoc Tukey s range test. RESULTS There was significant variation in mean total charges across small ($59,010.97 ± $55,211.71), medium ($63,775.99 ± $50,823.21) and large ($63,546.59 ± $54,831.45) hospitals (p=0.002). Post-hoc testing revealed significant differences in charge between small and medium hospitals (p=0.004) and between small and large hospitals (p=0.002). CONCLUSIONS Hospital size is a determining factor for cost of elective single-level ACDF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.