Claims Data Analysis on the Annual Frequency and Incremental Cost of Reoperations in Instrumental Spinal Surgeries in Germany

Abstract

Objectives: Complications in instrumental spinal surgeries (ISS) pose a considerable burden on patients. Necessary reoperations are associated with significant resource utilization and cost and from the perspective of the German Statutory Health Insurance (SHI). Dependable data on the frequency of reoperations and associated costs are lacking for Germany. The aim of this study was to estimate the incidence of ISS and consecutive reoperations, and to calculate the related costs. MethOds: We conducted a retrospective claims data analysis using the Health Risk Institute research database, which contains anonymized claims data and covers approximately 5.42% of the German population. The study period comprised 01 January 2009 to 31 December 2011. An algorithm of operation and procedure codes (OPS) identified primary ISS and following reoperations. Reoperation rates were calculated for an individual period of 12 months after the primary ISS in 2010. Annual costs for reoperations were calculated based on group comparison of patients with reoperation and those without reoperation (control group). Existing differences in cost levels in the year before the primary ISS were adjusted by the difference in differences approach. Results: A total of 3,316 individuals had a primary ISS in 2010. The reoperation rate was 9.98% (95% CI = 8.98% to 11.02%). Mean cost per ISS was € 11,331 for all patients (€ 13,358 reoperation group, € 11,106 control group). The mean adjusted annual cost for a reoperation was € 11,370, with € 8,432 directly attributed to the reoperation procedure and € 2,938 to excess costs in the first year after the primary ISS. cOnclusiOns: The direct cost of ISS has a significant impact on health insurance budgets. With 10% of primary ISS patients requiring a reoperation in Germany, their associated annual costs are relevant from the SHI perspective. As demonstrated elsewhere, these cost might be partly avoidable by using intra-operative 3-D imaging with navigation.Objectives: This study aims to estimate the incidence and costs of osteoporotic fractures in The Netherlands in 2010 and project them to 2030. MethOds: The incidence and health care costs of fractures were derived from claims data of all health care insurers in The Netherlands. We obtained 5-year age-and gender-specific costs of patients with and without fractures. Cost included hospital admission, physical therapy, occupational therapy, general practitioner and medication. In order to attribute fractures to osteoporosis we used a large dataset from a general hospital that included patients with a fracture screened with Dexa scan. Future projections were based on four different scenarios: 1. demographic scenario, 2. demographic+trend in incidence scenario, 3. demographic+trend in incidence+trend in cost scenario, and 4. increased treatment scenario. Results: Of all registered fractures 32% could be attributed to osteoporosis. In women this percentage was larger than in men (36 versus 21 %). This resulted in an incidence for all osteoporotic fractures of ...

Screening patients requiring secondary lumbar surgery for degenerative lumbar spine diseases: a nationwide sample cohort study

“…Secondly, we hypothesized that higher medical costs could be linked to poor clinical outcomes. However, medical resource utilization varied among patients and doctors, and the study did not consider the impact of time on surgical outcomes 50 . Thirdly, the medical cost claims data lacked comprehensive clinical and imaging details.…”