Regional Variation in 90-Day Postoperative Costs Among Patients Undergoing Posterior Lumbar Fusion (PLF): Insights From the Optum Labs Data Warehouse (OLDW)

Abstract

Abstract INTRODUCTION Lumbar spine surgery has been reported to be associated with extremely high direct and associated costs and has thus been prioritized as a target for several quality improvement interventions. We aimed to identify factors associated with higher 90-d costs following elective posterior lumbar fusion (PLF) for degenerative lumbar spine disease among patients with commercial insurance and those on Medicare Advantage, using an administrative database. METHODS Optum Labs Data Warehouse was queried for patients undergoing PLF for degenerative lumbar spine disease between 2012 and 2015. Patients were stratified by insurance status (commercial or Medicare Advantage) and by the 9 US census regions. The primary outcome was all postoperative 90-d costs. RESULTS A total of 25 556 patients underwent a PLF, of which 67.6% had commercial insurance and 32.4% had Medicare Advantage. Regional 90-d adjusted mean costs per patient varied significantly between the 2o insurance groups, most notably for patients with commercial insurance ($123,950.38 for Mid-Atlantic region to $59,213.52 for patients in East South Central region). Multivariable regression analyses revealed that geographic region where surgery was performed, the number of operated levels, number of readmissions and number of ED visits were significantly associated with higher costs for each procedure. CONCLUSION There is significant regional variation in 90-d postoperative adjusted costs for patients on commercial and Medicare insurance undergoing PLF. These analyses are important to help surgeons develop region-specific interventions to alleviate the cost burden for patients and assist policy makers in designing more effective reimbursement policies for providers and hospitals.