38. Trends in total charges and utilization of computer-assisted navigation in thoracolumbar spine surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Computer-assisted navigation (CAN) was developed to improve visualization inside the human body during surgery. This technology allows surgeons to more readily contextualize anatomical structures during complex procedures. The goal of CAN is to improve the accuracy and reproducibility of surgeries. <h3>PURPOSE</h3> Given the increased adoption of CAN for spine surgery, the objective of this study is to assess the charges, trends and usage of CAN in thoracolumbar spine surgery over time in order to better inform surgeons to changes in practice. <h3>METHODS</h3> The 2012-2016 National Readmission Databases (NRD) were queried for patients with ICD-9 and ICD-10 codes for computer-assisted procedures of the thoracolumbar region. Nonelective cases and patients <18 years of age were excluded. Analysis of patient demographics, surgical data, readmissions, and total charges was performed. Comorbidity burden was calculated using the Charlson and Elixhauser comorbidity index. Complication rates were identified based on diagnosis codes. <h3>RESULTS</h3> Following inclusion and exclusion criteria, 6,598 total patients were included, with 246 in 2012, 134 in 2013, 30 in 2014, 2,169 in 2015, and 4,019 in 2016 (Pearson correlation coefficient = 0.866, p = 0.057). Average total charge to a patient in 2016 was $142,013, which is greater than the 2012-2014 mean total charges of $126,698, $111,738, $115,120, and similar to the 2015 mean total charge of $148,134 (Pearson correlation coefficient = 0.660, p = 0.225). The ratio of patients covered under Medicare to those covered by private insurance increased from 0.822 in 2012 to 1.27 in 2016 (Pearson correlation coefficient 0.687, p = 0.313). <h3>CONCLUSIONS</h3> The use of and charges related to CAN in thoracolumbar surgeries has increased overall from 2012-2016, most notably indicated by the steep upward trend in use of this technology in 2016. This indicates an increasing adoption of a more recent innovation in assistive surgical technology, and an associated cost burden that comes with it. CAN has the potential to improve surgical outcomes, but as utilization grows and CAN becomes the standard in thoracolumbar spine surgeries, the charges for care also increase for more patients. As a result, further studies need to be conducted to determine whether the use of CAN is efficient in terms of cost and improvement of patient care. Limitations of this include the fact that there is no ICD-9 code for the use of CAN in thoracolumbar surgery specifically, so patient population was estimated using ICD-9 codes for CAN general use coupled with ICD-9 codes for thoracolumbar surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.