Surgeon Choices, and the Choice of Surgeons, Affect Total Hospital Charges for Single-Level Anterior Cervical Surgery

Abstract

This retrospective study assessed the total hospital charges for performing 102 single-level anterior cervical discectomy/fusion (1-ADF) procedures performed during a single year at one institution. All cases were in a single diagnosis-related group (DRG) category (473: cervical spine fusion), and used a single Principle Procedure Code (81.02). To examine the variations in total hospital charges and to determine the extent to which surgeons affected these charges. Little is known about the variability in total hospital charges for performing 1-ADF, and how the surgeon affects these charges. In 2008, 15 surgeons performed 102 1-ADF without comorbidities at a single institution. A total of 80 patients exhibited no myelopathy (ICD-9: 722.0), while 22 were myelopathic (ICD-9-CM: 722.71). The total hospital charges (total charges) were divided into in-patient hospital charges (e.g., room charge/length of stay [LOS], diagnostic studies), and surgical charges. Surgical charges were subdivided into operative charges (operating room, anesthesia, recovery room charges), instrumentation charges (plates/screws, spacers/implants), and supply charges (bone graft supplements). In addition, the total hospital charges were analyzed for the 6 surgeons doing 8 or more cases. The total hospital charges per patient ranged from $26,653 to $129,220 (a factor of 4.8). The in-patient hospital charges, which ranged from $15,113 to $76,687 (a factor of 5.0), were largely influenced by differing LOS (1-11 days). There was also a large variation in surgical charges, which was largely attributable to the surgeon's choice of instrumentation. Instrumentation charges per patient ranged from $4062 to $40,409 (a factor of 10). The average in-patient hospital and surgical charges of 1 of the 6 surgeons clearly exceeded the averages for the others. Both the surgeon's choice of instrumentation and the choice of surgeons contributed to large- variations in total hospital charges for 102 patients undergoing 1-ADF.