P94. Years of experience and primary specialty are correlated with total cost of ACDF surgeries for Medicare beneficiaries

Abstract

<h3>BACKGROUND CONTEXT</h3> The high costs of spine surgery are multifactorial. Many studies suggest hospital, geographic, surgeon and patient-specific factors impact the cost of spine surgical care, but results vary significantly between studies using different datasets. <h3>PURPOSE</h3> Our goal was to identify the factors correlated with total costs for Medicare beneficiaries undergoing one of the most common spine surgical procedures, anterior cervical discectomy and fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> We identified all patients undergoing ACDF (CPT code 22551) from the 20% sample Medicare carrier files from January 1, 2013, through December 31, 2015 (n = 15,456). Subjects were stratified by number of levels operated on. <h3>OUTCOME MEASURES</h3> Variables collected including hospital location, number of beds and wage index; patient age, sex, race and length of stay; physician industry payments, years since medical school and primary specialty. Outcomes were predictors of total cost and operating room cost of ACDF, and patient length of stay. <h3>METHODS</h3> Medicare carrier and MedPAR files were used to find the total charge, operating room charge and length of stay of each ACDF procedure. Charges were converted to costs using the hospital-specific cost-to-charge ratios from the IPPS Impact Files for each year. The Open Payments database and NPI National Downloadable File were used to identify the operating surgeon for each ACDF procedure. Univariate and multivariate analyses were used to identify patient-specific, hospital-specific and physician-specific factors associated with changes in cost of ACDF or patient length of stay. <h3>RESULTS</h3> Matching across all relevant files resulted in 5,202 1-level ACDF Medicare claims. The mean total cost for a 1-level ACDF from 2013-2015 was $13,592 (+/- $5,324). Multiple linear regression found that, after controlling for patient and hospital factors, the total cost of a 1-level ACDF was $677 higher when performed by an orthopedic surgeon than a neurosurgeon (p < 0.001). Multiple linear regression also found a significant negative association between years since the surgeon graduated medical school and total hospital cost of 1-level ACDF (p < 0.001). A significant positive association was found between hospital wage index and total cost of 1-level ACDF (p < 0.001). No significant relationship was found between total ACDF cost and patient age, race or sex. <h3>CONCLUSIONS</h3> Our multivariate analysis of hospital, surgeon, and patient-specific factors identifies that surgeon's primary specialty, surgeon's years of experience, and hospital wage index are significant factors impacting the total cost of ACDF surgery for Medicare beneficiaries. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.