Wednesday, September 26, 2018 2:00 PM – 3:00 PM Increasing Value: Lumbar Spine Surgery: 63. Assessing variation in cost- and episode-based outcomes between surgical services for patients undergoing posterior lumbar fusion

Abstract

BACKGROUND CONTEXT Spinal fusion is becoming a bundled payment candidate; identification of factors that drive variation in cost and episode-based quality metrics is crucial for this system to be viable. Posterior lumbar fusion (PLF) is regularly performed by multiple surgical services, representing a variable to be evaluated. PURPOSE To understand if surgical service influences episode-based outcomes such as readmissions, length of stay (LOS), cost of hospitalization, and unplanned care for patients undergoing PLF. STUDY DESIGN/SETTING All patients undergoing PLF by a spine surgeon at a single institution between January 1, 2006 and November 30, 2016 were included. Patients were identified using the Current Procedural Terminology (CPT) codes 22633, 22612 and 22630. PATIENT SAMPLE This study included a total of 3,225 patients from a single institution. OUTCOME MEASURES Outcome variables included cost of hospitalization and the following postoperative outcomes: reoperation, length of stay (LOS), discharge disposition, intensive care unit (ICU) stay, length of ICU stay, emergency room (ER) visit within 30 and 90 days, readmission within 30 and 90 days, and death. METHODS Cases were separated based on whether the primary surgeon was an orthopedic surgeon or a neurological surgeon. Student's t tests were used to compare continuous variables between the two cohorts; chi-square tests and Fisher's Exact test were used to compare categorical variables. Continuous outcome variables were further compared using linear regression, adjusting for age, ASA status and gender, while using surgeon specialty as the exposure variable. Categorical outcome variables were further compared using logistic regression, with surgical specialty, ASA status, age and gender included in the models. Direct costs were compared between the two cohorts using linear regression, adjusting for age, sex, ASA class and emergency procedure designation. RESULTS There were a higher proportion of ASA three or four patients in the neurological surgeon cohort (44.32% vs. 30.62%, p CONCLUSIONS Results indicate that surgical service contributes to variation in resource utilization, cost and postoperative outcomes for patients undergoing PLF. This warrants further investigation into surgical specialty as a driver for cost and postoperative outcomes for other procedures commonly performed by more than one surgical specialty. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.