Cost and Hospital Resource Utilization of Staphylococcus aureus Infection Post Elective Posterior Instrumented Spinal Fusion Surgeries in U.S. Hospitals: A Retrospective Cohort Study

Rosenthal, Ning; Heinrich, Kirstin; Chung, Jessica; Yu, Holly

doi:10.1097/brs.0000000000002898

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…Rosenthal et al conducted a study assessing cost and hospital utilization related to postsurgical staph aureus superficial site infection (SSI) and blood stream infection (BSI) during a 180-day follow up period post elective spine fusion. 24 The study found that the rate of contracting a S. aureus during the 180-day period was 2.22%. Additionally, 96.03% of patients with invasive S. aureus infection had at least one readmission compared with 19.18% patients without S. aureus infection.…”

Section: Resultsmentioning

confidence: 96%

Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome

Eli

Whitmore

Ghogawala

2021

Global Spine Journal

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Study Design: Review article. Objectives: There have been substantial increases in the utilization of complex spinal surgery in the last 20 years. Spinal instrumented surgery is associated with high costs as well as significant variation in approach and care. The objective of this manuscript is to identify and review drivers of instrumented spine surgery cost and explain how surgeons can reduce costs without compromising outcome. Methods: A literature search was conducted using PubMed. The literature review returned 217 citations. 27 publications were found to meet the inclusion criteria. The relevant literature on drivers of spine instrumented surgery cost is reviewed. Results: The drivers of cost in instrumented spine surgery are varied and include implant costs, complications, readmissions, facility-based costs, surgeon-driven preferences, and patient comorbidities. Each major cost driver represents an opportunity for potential reductions in cost. With high resource utilization and often uncertain outcomes, spinal surgery has been heavily scrutinized by payers and hospital systems, with efforts to reduce costs and standardize surgical approach and care pathways. Conclusions: Education about cost and commitment to standardization would be useful strategies to reduce cost without compromising patient-reported outcomes after instrumented spinal fusion.

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Section: Resultsmentioning

confidence: 96%

Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome

Eli

Whitmore

Ghogawala

2021

Global Spine Journal

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“…The data that support the ndings of this study are available from Premier Healthcare Solutions, Inc. (Charlotte NC), but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. [2,22]. The protocol for this study was nonetheless submitted to Western IRB (Puyallup WA), which con rmed its exempt status.…”

Section: Declarationsmentioning

confidence: 99%

“…Data from the PHD are thus considered deidenti ed in accordance with the HIPAA Privacy Rule described in Title 45 of the US Code of Federal Regulations (CFR) Part 164.506(d)(2)(ii)(B) and are exempt from Institutional Review Board (IRB) oversight, as provided in 45 CFR 46.101(b)(4 [2,22]. The protocol for this study was nonetheless submitted to Western IRB (Puyallup WA), which con rmed its exempt status.…”

Section: Study Design Data Source and Participant Selectionmentioning

confidence: 99%

“…Lumbar spine disorders are among the most prevalent medical diagnoses across the globe [1] and spinal fusion surgeries are a common and historically successful intervention [2]. Autologous iliac crest bone grafts (ICBG) are traditionally preferred for these procedures due to their presumed potential to provide all three necessary properties for bone fusion (ie, osteoconductivity, osteoinductivity, and osteogenicity) [3].…”

Section: Introductionmentioning

confidence: 99%

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A Large Database Study of Hospitalization Charges and Follow-up Re-admissions in Us Lumbar Fusion Surgeries Using a Cellular Bone Allograft (CBA) Versus Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

Wetzell

McLean

Moore

et al. 2020

Preprint

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BackgroundThis retrospective study of a large US healthcare system database compared initial procedure and 12-month follow-up hospitalization charges and resource utilization (lengths of stay; LOS) for lumbar fusion surgeries using either recombinant human bone morphogenetic protein-2 (rhBMP‑2) or a cellular bone allograft comprised of viable lineage-committed bone cells (V‑CBA). Potentially-relevant re-admissions during the follow-up period were also assessed.MethodsA total of 16,172 patients underwent lumbar fusion surgery using V-CBA or rhBMP-2, of whom 3,503 (21.66%) patients had follow-up re‑admission data. Initial patient, procedure, and hospital characteristics were assessed to determine confounding factors. Multivariate regression modeling compared differences in hospitalization charges (in 2018 US dollars) and LOS (in days) between the groups, as well as incidences of potentially-relevant re‑admissions during the 12‑month follow‑up period.ResultsThe adjusted mean initial procedure and 12-month follow‑up hospital charges were significantly lower in the V-CBA group versus the rhBMP‑2 group ($109,061 and $108,315 versus $160,191 and $130,406, respectively; P<0.0001 for both comparisons). This disparity remained in an ad hoc comparison of charges for initial single-level treatments only (V‑CBA = $103,064, rhBMP-2 = $149,620; P<0.0001).The adjusted mean initial LOS were significantly lower in the V‑CBA group (3.77 days) versus the rhBMP-2 group (3.88 days; P<0.0001), but significantly higher for the cumulative follow-up hospitalizations in the 12‑month follow-up period (7.87 versus 7.46 days, respectively; P<0.0001). Differences in rates of follow-up re‑admissions aligned with comorbidities at the initial procedure. Subsequent lumbar fusion rates were comparable, but significantly lower for V-CBA patients who had undergone single-level treatments only, in spite of V‑CBA patients having significantly higher rates of initial comorbidities that could negatively impact clinical outcomes.ConclusionsThe results of this study indicate that use of V-CBA for lumbar fusion surgeries performed in the US may result in substantially lower overall hospitalization charges versus rhBMP-2, with both exhibiting similar rates of 12-month re-admissions and subsequent lumbar fusion procedures.

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“…Surgical site infection (SSI) is among the most serious complications of spinal surgery in terms of the health status and clinical outcomes of patients as well as costs. 1,2 Despite prophylactic antibiotics and aseptic techniques, SSIs occur at a rate of 0.6%-11.9% in patients undergoing spinal surgery. 3−5 Given these circumstances, various attempts have been made to reduce the incidence of infections after spinal surgeries.…”

mentioning

confidence: 99%

Prediction tool for high risk of surgical site infection in spinal surgery

Namba¹,

Ueno

Inoue

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective:The incidence of surgical site infection (SSI) is higher in spinal surgeries than in general orthopedic operations. In this study, we aimed to develop a scoring system with reduced health care costs for detecting spinal surgery patients at high risk for SSI.Design:Retrospective cohort study.Patients:In total, 824 patients who underwent spinal surgery at 2 university hospitals from September 2005 to May 2011.Methods:We reviewed the medical records of 824 patients, and we examined 19 risk factors to identify high-risk patients. After narrowing down the variables by univariate analysis, multiple logistic analysis was performed for factors with P values <.2, using SSI as a dependent variable. Only factors that showed P values <.05 were included in the final models, and each factor was scored based on the β coefficient values obtained. The clinical prediction rules were thereby prepared.Results:“Emergency operation,” “blood loss >400 mL,” “presence of diabetes,” “presence of skin disease,” and “total serum albumin value <3.2 g/dL” were detected by multivariable modeling and were incorporated into the risk scores. Applying these 5 independent predictive factors, we were able to predict the infection incidence after spinal surgery.Conclusions:Our present study could aid physicians in making decisions regarding prevention strategies in patients undergoing spinal surgery. Stratification of risks employing this scoring system will facilitate the identification of patients most likely to benefit from complex, time-consuming and expensive infection prevention strategies, thereby possibly reducing healthcare costs.

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Cost and Hospital Resource Utilization of Staphylococcus aureus Infection Post Elective Posterior Instrumented Spinal Fusion Surgeries in U.S. Hospitals: A Retrospective Cohort Study

Cited by 15 publications

References 26 publications

Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome

Spine Instrumented Surgery on a Budget—Tools for Lowering Cost Without Changing Outcome

A Large Database Study of Hospitalization Charges and Follow-up Re-admissions in Us Lumbar Fusion Surgeries Using a Cellular Bone Allograft (CBA) Versus Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2)

Prediction tool for high risk of surgical site infection in spinal surgery

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