Abstract
Retrospective cross-sectional database analysis. The cost of spine surgery is growing exponentially, and cost-effectiveness is a critical consideration. Smoking has been shown to increase hospital costs in general surgery, but this impact has not been reported in patients with spinal disease. The objective of this work was to evaluate the effect of smoking on cost and complications in a large sample of patients admitted for treatment of spinal disease. In 2012, the authors identified all inpatient admissions to all University HealthSystem Consortium (UHC) hospitals from 2005 to 2011 for spinal disease based on the principal diagnosis ICD-9-CM codes from the prospectively collected UHC database. Patient outcomes - including length of stay; complication, readmission, intensive care unit admission rates; and total cost - were compared for non-obese smokers and non-smokers using a two-sample t-test. There were 137,537 patients, including 136,511 (122,608 non-smokers and 13,903 smokers) in the 4 largest diagnostic groups. Smoking was associated with increased complications and worse outcomes in three of these four groups. All outcomes in the two largest groups - fracture and dorsopathy - were worse in the smoking patients. Smoking patients admitted for spinal disease in the sample had worse outcomes, increased complications, and higher costs than their non-smoking counterparts. In the current health-care climate focused on cost-effectiveness, smoking represents a potentially modifiable area for cost reduction.
Highlights
1.2 million spinal surgeries are performed annually in the United States for traumatic, oncologic, degenerative, and other conditions [1, 2]
Patient Population In 2012, the authors queried the University HealthSystem Consortium (UHC) database in a retrospective cross-sectional analysis of all UHC hospitals from 2005 to 2011 to identify all inpatient admissions for treatment of spinal disease based on the principal diagnosis ICD-9-CM codes, including cord injury, congenital, curvature, dislocation, dorsopathy, which is defined as “a condition in which there is a deviation from or interruption of the normal structure or function of the spine,” fracture, and sprains/strains
There were a total of 137,537 non-obese patients admitted with spinal disease during the study period among all pathology groups, including 136,511 total patients among the dorsopathy, fracture, curvature, and congenital groups, the four largest cohorts
Summary
1.2 million spinal surgeries are performed annually in the United States for traumatic, oncologic, degenerative, and other conditions [1, 2]. Smoking effect on cost and outcome general has been at its lowest recorded rates of the last 50 years, at 3.8 and 3.9%, respectively, for 2009 and 2010, spine care expenditures as recently as 2005 were estimated to have increased 65% from their 1997 levels [3]. There has been a call by the Institutes of Medicine [5] for research on cost-effectiveness in many fields of medicine, including spine surgery, to help define and improve value in medical care To address this call, the medical community will need to identify the optimal treatment strategies based on cost-effective studies and to understand patient and hospital variables that may impact the overall cost, both monetary and non-monetary, of these procedures
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