Martin Quirno

Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases.

BACKGROUND Although achieving clinical success is the main goal in the surgical treatment of adolescent idiopathic scoliosis, it is becoming increasingly important to do so in a cost-effective manner. The goal of the present study was to determine the surgical and hospitalization costs, charges, and reimbursements for adolescent idiopathic scoliosis correction surgery at one institution. METHODS We performed a retrospective review of 16,536 individual costs and charges, including overall reimbursements, for 125 consecutive patients who were managed surgically for the treatment of adolescent idiopathic scoliosis by three different surgeons between 2006 and 2007. Demographic, surgical, and radiographic data were recorded for each patient. Stepwise multiple linear regression analysis was employed to assess independent correlation with total cost and charge. Nonparametric descriptive statistics were calculated for total cost with use of the Lenke curve-classification system. RESULTS The mean age of the patients was 15.2 years. The mean main thoracic curve measured 50 degrees, and the thoracolumbar curve measured 41 degrees. The cost varied with Lenke curve type:

Comparative charge analysis of one- and two-level lumbar total disc arthroplasty versus circumferential lumbar fusion.

29,955 for type 1,

Cost-Effectiveness of a Staphylococcus aureus Screening and Decolonization Program for High-Risk Orthopedic Patients

31,414 for type 2,

Annexin A6 Interacts With p65 and Stimulates NF‐κB Activity and Catabolic Events in Articular Chondrocytes

31,975 for type 3,

The reliability of computed tomography and magnetic resonance imaging grading of lumbar facet arthropathy in total disc replacement patients.

60,754 for type 4,

Analysis of segmental cervical spine vertebral motion after prodisc-C cervical disc replacement.

32,652 for type 5, and

Effect of Intervertebral Disc Height on Postoperative Motion and Outcomes After ProDisc-L Lumbar Disc Replacement

33,416 for type 6. Independently significant increases for total cost were found in association with the number of pedicle screws placed, the total number of vertebral levels fused, and the type of surgical approach (R(2) = 0.35, p <or= 0.03). Independently significant increases for reimbursement were found in association with the number of pedicle screws placed and the type of surgical approach (R(2) = 0.12, p <or= 0.02). The hospital was reimbursed 53% of total charges and 120% of total costs. Reimbursement was highly correlated with charge (r = 0.45, p < 0.001). For rehospitalizations, the hospital was reimbursed 65% of charges and 93% of costs. CONCLUSIONS The largest contributors to overall cost were implants (29%), intensive care unit and inpatient room costs (22%), operating room time (9.9%), and bone grafts (6%). There were three significant independent predictors of increased total cost: the surgical approach used, the number of pedicle screws placed, and the number of vertebral levels fused. This study characterizes the relative contributions of factors that contribute to total costs, charges, and reimbursements that can, in time, identify potential areas for cost reduction or redistribution of resources in the surgical treatment of adolescent idiopathic scoliosis.

Intervertebral foramen size and volume changes in low grade, low dysplasia isthmic spondylolisthesis.

Study Design. This is a retrospective, independent study comparing 2 groups of patients treated surgically for discogenic low back pain associated with degenerative disc disease (DDD) in the lumbosacral spine. Objective. To compare the surgical and hospitalization charges associated with 1- and 2-level lumbar total disc replacement and circumferential lumbar fusion. Summary of Background Data. Reported series of lumbar total disc replacement have been favorable. However, economic aspects of lumbar total disc replacement (TDR) have not been published or studied. This information is important considering the recent widespread utilization of new technologies. Recent studies have demonstrated comparable short-term clinical results between TDR and lumbar fusion recipients. Relative charges may be another important indicator of the most appropriate procedure. We report a hospital charge-analysis comparing ProDisc lumbar disc replacement with circumferential fusion for discogenic low back pain. Methods. In a cohort of 53 prospectively selected patients with severe, disabling back pain and lumbar disc degeneration, 36 received Synthes ProDisc TDR and 17 underwent circumferential fusion for 1- and 2-level degenerative disc disease between L3 and S1. Randomization was performed using a 2-to-1 ratio of ProDisc recipients to control spinal fusion recipients. Charge comparisons, including operating room charges, inpatient hospital charges, and implant charges, were made from hospital records using inflation-corrected 2006 U.S. dollars. Operating room times, estimated blood loss, and length of stay were obtained from hospital records as well. Surgeon and anesthesiologist fees were, for the purposes of comparison, based on Medicare reimbursement rates. Statistical analysis was performed using a 2-tailed Student t test. Results. For patients with 1-level disease, significant differences were noted between the TDR and fusion control group. The mean total charge for the TDR group was

A Comparison of Two Retroperitoneal Surgical Approaches for Total Disc Arthroplasty of the Lumbar Spine

35,592 versus

Survivorship of coflex Interlaminar-Interspinous Implant.

46,280 for the fusion group (P = 0.0018). Operating room charges were