Understanding Costs in a 90-Day Episode of Care Following Posterior Spinal Fusions for Adolescent Idiopathic Scoliosis

Abstract

To understand cost distribution in a 90-day episode of care following posterior spinal fusions (PSFs) for adolescent idiopathic scoliosis (AIS). The 2007-2016 Humana PearlDiver dataset was queried using Current Procedural Terminology codes (22800, 22802, 22804, 22842, 22843, and 22844) to identify patients with AIS, aged 10-19 years, receiving PSFs. The following categories were used to define distribution in 90-day costs: 1) facility costs, 2) surgeon costs, 3) anesthesia costs, 4) intraoperative neuromonitoring, 5) hospital services and investigations, 6) intensive care unit stay, 7) radiology, 8) physical therapy/rehabilitation, 9) office visits, and 10) readmissions. A total of 455 patients with AIS received PSFs, of whom 381 (83.7%) were commercial insurance beneficiaries and 74 (16.3%) were Medicaid beneficiaries. The overall average 90-day cost of surgery was $124,360 with the 90-day stipulated bundled prices being $136,302 and $62,871 for commercial and Medicaid beneficiaries, respectively. Facility costs comprised 85%-92% of the 90-day cost, followed by surgeon costs (5.2%-5.7%). Post-acute care (physical therapy/rehab and office visits) was not a major driver of the 90-day cost (0.2%-0.3%). Significant independent predictors of increased 90-day costs were-increased co-morbidity burden (+$11,284), ≥7 levels fusion (+$65,330), and length of stay (+$5298/day). Medicaid (-$81,957) payer type was associated with lower 90-day costs. Facility costs are a major determinant of overall 90-day costs following PSFs in AIS. Providers should aim at optimizing the co-morbidity burden and constructing accelerated care-pathways to decrease the length of stay and reduce the cost of the entire episode of care.