Variation in 90-Day Postoperative Costs Among Patients Undergoing Elective Anterior Cervical Discectomy and Fusion: Insights From the OPTUM Labs Data Warehouse (OLDW)

Abstract

Abstract INTRODUCTION Anterior Cervical Discectomy and Fusion (ACDF) has been shown to be associated with high direct and associated costs. We aimed to identify factors associated with higher 90-day costs following elective ACDF for degenerative cervical spine disease among patients with commercial insurance and those on Medicare Advantage, using an administrative database. METHODS Optum Labs Data Warehouse (OLDH) was queried for patients undergoing an anterior cervical decompression and fusion (ACDF) for degenerative cervical spine disease. between 2012 and 2015. Geographic variations were evaluated as per U.S. Census Division. 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 29 380 patients underwent an ACDF of which 86.7% patients had commercial insurance while 13.3% had Medicare Advantage. Regional 90-d adjusted mean costs per patient varied significantly between the 2 insurance groups, most notably for patients with commercial insurance undergoing ACDF ($70,765.17 for Mid-Atlantic to $29,364.02 for East South Central). Multivariable regression analyses revealed that the geographic region where procedure was performed, number of operated levels, number of readmissions and number of ED visits were significantly associated with higher costs. CONCLUSION There is significant regional variation in 90-d postoperative adjusted costs for patients on commercial and Medicare insurance undergoing elective ACDF. These analyses are important to help surgeons develop region-specific interventions to alleviate the cost burden for patients and assist policymakers in designing better risk-adjusted reimbursement policies for providers and hospitals.