40. Posterior cervical fusion for fracture vs degenerative cervical spine disease: implications for a bundled payment model

Abstract

BACKGROUND CONTEXT Current bundled payment models for cervical fusions, such as the Bundled Payments for Care Improvement (BCPI) revolve around the use of Diagnosis-Related-Groups (DRGs) to categorize patients for reimbursement purposes. Though a posterior cervical fusion (PCF) performed for a fracture may have a different postoperative course of care as compared to a fusion being done for degenerative cervical spine pathology, the current DRG system does not differentiate patients based on the indication/cause of surgery. PURPOSE Understand differences in 30-day outcomes between patients undergoing PCF for fracture vs degenerative cervical spine disease. STUDY DESIGN/SETTING Retrospective review of prospectively collected registry. PATIENT SAMPLE The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology code 22600 to identify patients receiving elective posterior cervical fusions. Patients undergoing anterior fusions, combined anterior-posterior surgery, surgery for deformity and tumors were excluded to capture an isolated cohort of patients receiving fusion for fractures or degenerative cervical pathology. OUTCOME MEASURES Rates of 30-day adverse events, readmissions, length of stay and non-home discharge. METHODS Multivariate analyses were used to compare rates of 30-day severe adverse events (SAE), minor adverse events (MAE), readmissions, length of stay and non-home discharges between the two groups while controlling for differences in baseline clinical characteristics. RESULTS A total of 2,786 PCFs were included, out of which 2,546 (91.4%) were performed for degenerative cervical spine pathology and 240 (8.6%) for fracture. Following adjustment for differences in baseline clinical characteristics, patients undergoing a PCF for a fracture vs degenerative pathology had higher odds of severe adverse events (18.8% vs 10.6%, OR 1.65 [95% CI 1.10-2.46]; p=0.015), prolonged length of stay >3 days (54.2% vs 40.5%, OR 1.93 [95% CI 1.44-2.59]; p CONCLUSIONS Patients undergoing PCFs for fracture have significantly higher rates of postoperative adverse events and greater resource utilization as compared to individuals undergoing elective PCF for degenerative spine pathology. The study calls into question the need of risk-adjustment of bundled-prices based on indication/cause of the surgery to prevent the creation of a financial disincentive when taking care/performing surgery in spinal trauma patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.