Greater Direct Costs Research Articles

Utilization of the American Society of Anesthesiologists (ASA) classification system in evaluating outcomes and costs following deformity spine procedures.

Adult spinal deformity (ASD) has increased prevalence in aging populations. Due to the high cost of surgery, studies have evaluated risk factors that predict readmissions and poor outcomes. The American Society of Anesthesiologists (ASA) classification system has been applied to patients with ASD to assess preoperative health and assess the correlation between ASA class and postoperative complications. This study evaluates the relationship between ASA and complications, length of stay (LOS), and direct costs following spine deformity surgery. Patients undergoing spine deformity surgery at a single institution from 2008-2016 were included and stratified based upon ASA status. Primary outcomes included patient demographics, adjusted LOS, and cost of care. Secondary measures compared between cohorts included adverse events, non-home discharge, and readmission rates. 442 patients with ASD were included in this study. Higher ASA class was correlated with greater Elixhauser Comorbidity Index (ECI) scores (p < 0.0001) and older age (p < 0.0001). Univariate analysis showed longer LOS (p < 0.0001) and greater direct costs in patients with higher ASA class (p < 0.0001). Patients in ASA Class III or IV had the greatest incidence of ICU stay when compared to patients without systemic disease (p < 0.0001). Upon multivariable regression analysis, high ASA class was associated with higher rates of non-home discharge (OR 5.0, 95% CI 3.1-8.1). Direct costs were greater for higher ASA class (regression estimate = + $9,666, p = 0.002). This study demonstrates that ASA class is correlated with a more complicated postoperative hospital course, greater rates of non-home discharge, total direct costs in spine deformity patients.

P94. Anterior versus posterior approaches for idiopathic adolescent thoracolumbar scoliosis: a cost comparison

BACKGROUND CONTEXT Adolescent idiopathic thoracolumbar scoliosis (Lenke 5) can be operatively managed with anterior or posterior approaches. Each approach has unique surgical advantages and limitations. PURPOSE To compare direct costs associated with anterior and posterior operations for thoracolumbar scoliosis in children. STUDY DESIGN/SETTING Single-center retrospective cohort. PATIENT SAMPLE Adolescents who underwent anterior or posterior operations for thoracolumbar AIS (Lenke 5). OUTCOME MEASURES Total and direct costs. METHODS Consecutive review of adolescents (age>10 years) who underwent anterior or posterior operations for thoracolumbar scoliosis (Lenke 5) at a single institution by a single surgeon. Inclusion criteria included idiopathic scoliosis, curve magnitude >450, and non-structural thoracic scoliosis. Direct costs of the index hospitalization were identified from medical billing data. Not included in direct cost data were charges and surgeon fees. Costs data were stratified and compared based on the surgical approach using non-paired Student T-tests; p RESULTS A total of 17 children (average age 15.3±1.9 years, girls-13, average curve magnitude 51.10±6.20) were analyzed. Ages and curve magnitudes were statistically similar between anterior (n=10; boys 2, girls 8) and posterior (n=7; girls 5) operations. Anterior operations had significantly fewer levels fused (5±0 vs 6±0.9), significantly longer OR times (449±40 v. 308±26 mins), and more patients admitted to ICU post-op (30% vs 14%). While hospital lengths of stay (LOS) (5±2.1 v. 4±0.5 days) were not different, 2 anterior patients had LOS>7 days due to difficult pain control and C. diff colitis. Anterior operations were associated with significantly greater direct costs ($40,161±$3,668 v. $34,469±$7,846). However, when the 2 anterior patients with extended LOS were excluded, direct costs were not statistically different (anterior: $39,990±$3,855 v. posterior: $34,469±$7,846). In addition to room/board and ICU care, supplies/instrumentation, and operating room services were major drivers of cost irrespective of approach. CONCLUSIONS For thoracolumbar AIS treated by anterior or posterior approaches, major drivers of cost were supplies/instrumentation, OR services, room/board, and ICU. Anterior operations had significantly greater direct costs due to more ICU admissions postoperative and more episodes of prolonged LOS. Minimizing LOS, ICU admissions, and postoperative complications are important to contain costs. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P533 Excellent long-term outcome in infliximab treated patients with chronic active ulcerative colitis

with comorbidities (N = 1849) vs those without (N = 1956) had significantly higher medical resource usage (0.46 vs 0.22 ED visits; 0.48 vs 0.27 overnight hospitalisations; 5.11 vs 2.81 hospital day visits; 16.62 vs 9.37 OP visits) and greater direct costs (Table). Conclusions: Employed UC pts with comorbidities had greater use of medical resources and higher medical costs, especially in moderate to severe UC. Treatment strategies for pts with UC should take into account comorbidities.