47. Economic consequences of waiting for lumbar disc herniation surgery

Abstract

<h3>BACKGROUND CONTEXT</h3> Despite the well-established benefits of lumbar discectomy, many patients wait for their surgery which delays their return to work and potentially increases health care costs. The economic repercussions of such delays have not been well studied. <h3>PURPOSE</h3> This study aims to provide meaningful comparisons of costs to decisions-makers who plan health care services. The main goal of this study was to quantify the cost differences in terms of direct and indirect costs of early surgery for symptomatic disc herniation compared to late surgery. In other words, this study aimed to unveil what is the cost of being on a surgical waitlist for a lumbar discectomy. Secondarily, we report PROS and compared the proportions of patients reaching meaningful patient reported outcomes (PROs) between early and late surgery. <h3>STUDY DESIGN/SETTING</h3> This is a retrospective analysis of prospectively collected data from the CSORN registry. <h3>PATIENT SAMPLE</h3> Comparisons were made between patients receiving surgery less than 60 days after consent (short wait) and 60 days or more after consent (long wait). <h3>OUTCOME MEASURES</h3> The Ontario Health Insurance Plan (OHIP) claims history database was used for direct costs estimates. Canada Income Statistics and the human capital method were used to calculate indirect costs. The primary outcome was defined as the cost difference between short wait and long wait groups to determine the overall cost of waiting for surgery. <h3>METHODS</h3> Continuous data are summarized using means and standard deviations, compared using Student's t-tests. Categorical data are expressed as numbers and percentages, compared using chi-square tests. The minimum clinically important difference (MCID) was defined as 30% improvement in NRS leg and NRS back from baseline to 3 months. The proportion of patients reaching MCID was compared between patients who returned to work at 3 months or not and between short- and long-wait groups. PROs at 3 months were adjusted for baseline score. A p-value <0.05 was considered statistically significant. Analyses were performed with IBM SPSS for Windows release 28. <h3>RESULTS</h3> A total of 493 patients were included in this study with 272 patients (55.2%) in the short-wait group and 221 patients (44.8%) in the long-wait group. Demographics were similar between the two groups. The proportions of patients who returned to work at 3 months and 12 months postoperatively were similar (p <0.596; p <0.798). Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p<0.804). Inherently, the longer wait group had significantly longer time from consent to return to work. This extended wait corresponded to an additional $11,753.10 indirect cost due to productivity loss while waiting for surgery. The short-wait group showed increased health care usage with patients more commonly visiting the emergency department (52.6% vs 25.0%, p <0.032), using physiotherapy (84.6% vs 72.0%, p <0.001) and receiving MRI (65.2% vs 41.4%, p <0.043). This corresponded to an additional direct cost of $518.21 per patient. The short wait group had higher baseline NPR leg, ODI, EQ5D, PCS and MCS. A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow-up in the short wait group (84.0% vs 75.9%, p <0.040). <h3>CONCLUSIONS</h3> Early surgery is associated with cost saving of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The higher health care utilization in patients receiving early surgery is counterbalanced by the additional productivity loss of the long waiters. From a societal economic perspective, early surgery seems beneficial and should be promoted. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.