63. Orthopedic vs neurosurgery: understanding 90-day complications and costs in patients undergoing elective 1- to 2-level posterior lumbar fusions by different specialties

Abstract

BACKGROUND CONTEXT Spine surgery is routinely performed by either orthopedic or neurological spine surgeons. Controversy still exists as to whether a provider's specialty (orthopedic vs neurosurgery) influences outcomes. PURPOSE With present evidence limited to inpatient-only and 30-day outcomes, the current study aims to understand differences in 90-day complication rates and health care resource utilization/costs between orthopedic and neurosurgical spine surgeons performing elective 1- to 2-level posterior lumbar fusions. STUDY DESIGN/SETTING Retrospective review of insurance claims from the Humana Commercial Database. PATIENT SAMPLE The 2007-2015Q2 Humana Commercial Database was queried using Current Procedural Terminology codes (22612, 22614, 22630, 22632, 22633 and 22634) to identify patients undergoing 1-to-2 level posterior lumbar fusions with active enrollment up to 90-days post-procedure. Patients undergoing fusion due to trauma, deformity and/or malignancy were excluded to capture a relevant study population of patients with degenerative lumbar pathology. OUTCOME MEASURES The 90-day complications included wound, pulmonary, cardiac, thromboembolic, sepsis, pneumonia, urinary tract infections, renal, dural tears and mechanical complications. Additional outcomes included emergency department (ED) visits, revision surgeries and readmissions within 90 days. The surgical and 90-day resource utilization costs for the two groups were compared, by studying average reimbursements for acute-care (index hospitalization, surgeon and anesthesia) and postacute care categories (office visits, nursing care, home health services, physical therapy, emergency department visits and readmissions). METHODS All 90-day complications and costs were compared using multivariable logistic and linear regression techniques while controlling for baseline differences in age, gender, race, region, Elixhauser Co-morbidity Index (ECI) and type of plan/benefit. RESULTS A total of 10,509 patients (5,523 = orthopedic, 4,986 = neurosurgery) underwent an elective 1- to 2- level posterior lumbar fusion during the time period. With the exception of a significantly lower odds of wound complications (OR 0.81) and a higher odds of dural tears (OR 1.29) in elective posterior lumbar fusions performed by orthopedic surgeons, no statistically strong differences were seen in 90-day complication rates between the two groups. Total 90-day costs were also similar between orthopedic and neurosurgeons, with the only exception being that surgeon reimbursement was lower for orthopedic surgery vs neurosurgery ($1,202 vs $1,372; p CONCLUSIONS A provider's specialty does not largely influence 90-day surgical safety outcomes and costs. The results of the study promote the formation and acceptance of dual training pathways for entry into the realm of spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.