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Scientific Articles   |    
Hospital Cost Analysis of Adolescent Idiopathic Scoliosis Correction Surgery in 125 Consecutive Cases
Jonathan R. Kamerlink, MD1; Martin Quirno, MD1; Joshua D. Auerbach, MD2; Andrew H. Milby, BS3; Lynne Windsor, BS4; Laura Dean, BA1; Joseph W. Dryer, MD1; Thomas J. Errico, MD1; Baron S. Lonner, MD1
1 Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU Medical Center, 820 2nd Avenue, #7A, New York, NY 10017
2 Department of Orthopaedic Surgery, Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, 1650 Selwyn Avenue, #13E, Bronx, NY 10457
3 University of Pennsylvania School of Medicine, 820 Second Avenue, Suite 7A, New York, NY 10017
4 Department of Finance, NYU Medical Center, 1 Park Avenue, 11th Floor, New York, NY 10016
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors, or a member of his or her immediate family, received, in any one year, payments or other benefits or a commitment or agreement to provide such benefits from commercial entities (DePuy, Fastenetix, K2M, Medtronic, Paradigm, Stryker, and Synthes [more than $10,000] and Axial Biotech and Fonar [less than $10,000]).

Investigation performed at NYU Hospital for Joint Diseases, New York, and NYU Langone Medical Center, New York, NY

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 May 01;92(5):1097-1104. doi: 10.2106/JBJS.I.00879
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Abstract

Background: 

Although achieving clinical success is the main goal in the surgical treatment of adolescent idiopathic scoliosis, it is becoming increasingly important to do so in a cost-effective manner. The goal of the present study was to determine the surgical and hospitalization costs, charges, and reimbursements for adolescent idiopathic scoliosis correction surgery at one institution.

Methods: 

We performed a retrospective review of 16,536 individual costs and charges, including overall reimbursements, for 125 consecutive patients who were managed surgically for the treatment of adolescent idiopathic scoliosis by three different surgeons between 2006 and 2007. Demographic, surgical, and radiographic data were recorded for each patient. Stepwise multiple linear regression analysis was employed to assess independent correlation with total cost and charge. Nonparametric descriptive statistics were calculated for total cost with use of the Lenke curve-classification system.

Results: 

The mean age of the patients was 15.2 years. The mean main thoracic curve measured 50°, and the thoracolumbar curve measured 41°. The cost varied with Lenke curve type: $29,955 for type 1, $31,414 for type 2, $31,975 for type 3, $60,754 for type 4, $32,652 for type 5, and $33,416 for type 6. Independently significant increases for total cost were found in association with the number of pedicle screws placed, the total number of vertebral levels fused, and the type of surgical approach (R2 = 0.35, p = 0.03). Independently significant increases for reimbursement were found in association with the number of pedicle screws placed and the type of surgical approach (R2 = 0.12, p = 0.02). The hospital was reimbursed 53% of total charges and 120% of total costs. Reimbursement was highly correlated with charge (r = 0.45, p < 0.001). For rehospitalizations, the hospital was reimbursed 65% of charges and 93% of costs.

Conclusions: 

The largest contributors to overall cost were implants (29%), intensive care unit and inpatient room costs (22%), operating room time (9.9%), and bone grafts (6%). There were three significant independent predictors of increased total cost: the surgical approach used, the number of pedicle screws placed, and the number of vertebral levels fused. This study characterizes the relative contributions of factors that contribute to total costs, charges, and reimbursements that can, in time, identify potential areas for cost reduction or redistribution of resources in the surgical treatment of adolescent idiopathic scoliosis.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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