PSU32 A Comparison of Resource Utilization and Medical Charges Among Lumbar Interbody Fusion Surgical Patients With and Without Revision

Abstract

2HealthMetrics Outcomes Research, Delray Beach, FL, USA OBJECTIVES: Compare resource utilization and medical charges among patients who had an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLF), or transforaminal posterior lumbar interbody fusion (T-PLIF) and a subsequent revision surgery to those without such a revision surgery. METHODS: The MedStat MarketScan databases from 2006 - 2009 were utilized for this retrospective analysis. Patients were included if had a ALIF, PLF, or T-PLIF and had continuous insurance coverage for 2 years post procedure. Revision patients were then matched to non-revision patients at a 2:1 ratio based upon type of initial procedure, year of birth, sex, and region of residence Medical payments and resource utilization were compared between the two cohorts using t-statistics for continuous variable and chi-square statistics for categorical variables. RESULTS: In the 2 years post procedure, patients with a subsequent revision were significantly more likely to visit a physical therapist (92% v 62%; P0.0001), receive an epidural steroid injection (58% v 47%; P0.0074), or visit the emergency room with a diagnosis of back pain (20% v 9%; P0.0001). The average cost the initial surgery was similar among the two cohorts ($39,925 v $38,341; P0.6422) while the mean cost associated with a revision surgery was $35,296 (std dev$32,814). Total payments for the two cohorts, ignoring the cost of the initial procedure was $33,180 for patients who did not have a subsequent revision, and $89,770 for patients with a subsequent revision (P0.0001). These differences translate into a $56,590 cost premium associated with a revision surgery ‐ 62% of which can be accounted by the revision surgery itself. CONCLUSIONS: Revision surgery was associated with significantly more resource utilization post initial surgery. Comparing costs among the two groups reveal a significant cost premium associated with revision surgery and that such costs extended beyond the cost of the revision surgery itself.