Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion

Durand, Wesley M.; Johnson, Joseph R.; Li, Neill Y.; Yang, JaeWon; Eltorai, Adam E.M.; DePasse, J. Mason; Daniels, Alan H.

doi:10.1016/j.spinee.2017.08.256

Cited by 13 publications

(14 citation statements)

References 18 publications

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“…1 For a sensitivity analysis of inpatient complications and discharge disposition status as additional confounders, we identified inpatient complications using ICD-9 codes derived from earlier neurosurgical NIS studies and followed the methods of Clement et al to dichotomize the NIS discharge disposition into favorable versus unfavorable status (Supplementary Table 3). 9,14,17 All reported results correspond to a −0.1 change in HHI (i.e., an increase in interhospital competition). Statistical significance was maintained at p < 0.05.…”

Section: Discussionmentioning

confidence: 72%

“…competitive intensity is associated with elevated charges. 9 Nonprice competition, rather than competition through enhanced outcomes, 5,11,33 may explain why we did not find an association between HHI and mortality, disposition, or complications, except for brain tumor craniotomy mortality. Interhospital competition likely influences hospital charges through several mechanisms, with variable effects on prices; further research is warranted to characterize interplay between these factors.…”

Section: Discussionmentioning

confidence: 78%

“…Several studies have suggested that competitive pressures in more hospital markets encourage institutions to invest in advertising to reach patients directly to maintain and grow their market share. 9,11,31 The impact of marketing intensity on higher patient satisfaction scores is pronounced in competitive markets. 31 Investment in these nonclinical expenditures may contribute to higher charges in these more competitive geographies.…”

Section: Discussionmentioning

confidence: 99%

“…Competitive markets may have a "medical arms race" that encourages hospitals to attract patients by acquiring novel technologies that may have little or no additional efficacy, contributing to higher patient billing. [9][10][11]33,34 However, more detailed data on hospital expenditures than are available in NIS are needed to examine these "hidden costs. "…”

Section: Discussionmentioning

confidence: 99%

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Interhospital competition and hospital charges and costs for patients undergoing cranial neurosurgery

Tang

Perla

Lim

et al. 2021

Journal of Neurosurgery

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OBJECTIVEResearch has documented significant growth in neurosurgical expenditures and practice consolidation. The authors evaluated the relationship between interhospital competition and inpatient charges or costs in patients undergoing cranial neurosurgery.METHODSThe authors identified all admissions in 2006 and 2009 from the National Inpatient Sample. Admissions were classified into 5 subspecialties: cerebrovascular, tumor, CSF diversion, neurotrauma, or functional. Hospital-specific interhospital competition levels were quantified using the Herfindahl-Hirschman Index (HHI), an economic metric ranging continuously from 0 (significant competition) to 1 (monopoly). Inpatient charges (hospital billing) were multiplied with reported cost-to-charge ratios to calculate costs (actual resource use). Multivariate regressions were used to assess the association between HHI and inpatient charges or costs separately, controlling for 17 patient, hospital, severity, and economic factors. The reported β-coefficients reflect percentage changes in charges or costs (e.g., β-coefficient = 1.06 denotes a +6% change). All results correspond to a standardized −0.1 change in HHI (increase in competition).RESULTSIn total, 472,938 nationwide admissions for cranial neurosurgery treated at 896 unique hospitals met inclusion criteria. Hospital HHIs ranged from 0.099 to 0.724 (mean 0.298 ± 0.105). Hospitals in more competitive markets had greater charge/cost markups (β-coefficient = 1.10, p < 0.001) and area wage indices (β-coefficient = 1.04, p < 0.001). Between 2006 and 2009, average neurosurgical charges and costs rose significantly ($62,098 to $77,812, p < 0.001; $21,385 to $22,389, p < 0.001, respectively). Increased interhospital competition was associated with greater charges for all admissions (β-coefficient = 1.07, p < 0.001) as well as cerebrovascular (β-coefficient = 1.08, p < 0.001), tumor (β-coefficient = 1.05, p = 0.039), CSF diversion (β-coefficient = 1.08, p < 0.001), neurotrauma (β-coefficient = 1.07, p < 0.001), and functional neurosurgery (β-coefficient = 1.11, p = 0.037) admissions. However, no significant associations were observed between HHI and costs, except for CSF diversion surgery (β-coefficient = 1.03, p = 0.021). Increased competition was not associated with important clinical outcomes, such as inpatient mortality, favorable discharge disposition, or complication rates, except for lower mortality for brain tumors (OR 0.78, p = 0.026), but was related to greater length of stay for all admissions (β-coefficient = 1.06, p < 0.001). For a sensitivity analysis adjusting for outcomes, all findings for charges and costs remained the same.CONCLUSIONSHospitals in more competitive markets exhibited higher charges for admissions of patients undergoing an in-hospital cranial procedure. Despite this, interhospital competition was not associated with increased inpatient costs except for CSF diversion surgery. There was no corresponding improvement in outcomes with increased competition, with the exception of a potential survival benefit for brain tumor surgery.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Interhospital competition and hospital charges and costs for patients undergoing cranial neurosurgery

Tang

Perla

Lim

et al. 2021

Journal of Neurosurgery

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“…Spinal cerrahi sonrası hastanede kalış süresi bir çok cerrahi ve cerrahi olmayan faktöre bağlı karmaşık bir yapıdır (17) . Yapılan çalışmalarda spinal cerrahi sonrası yatış süresini uzatan faktörler arasında ileri yaş (19,26,27) , alkol kullanım öyküsü (28) , konjestif kalp yetmezliği (29,30) , obezite (19,31) , anemi (32) , komplikasyonlar (derin ven trombozu (33) , solunum komplikasyonları (34) , implant ilişkili komplikasyonlar, genitoüriner komplikasyonlar, enfeksiyon ve nörolojik komplikasyonlar (35) ) ile ilişki olduğu belirlenmiştir (17,36) . İleri yaş ve eşlik eden hastalıklar, tüm cerrahi girişimlerde olduğu gibi spinal cerrahide de komplikasyonların gelişmesine ve dolayısıyla hastanede yatış süresinin uzamasına neden olabilmektedir (36) .…”

Section: Discussionunclassified

The Relationship Between Screws Number and Length of Stay in Transpedicular Fixation Surgery

İbrahimoğlu¹,

Akyol²

2020

jaren

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Sonuç: TPF ameliyatı; hastanede kalış süresinin kısa, kan kaybının az olması, erken mobilizasyon sağlaması ile güvenilir bir yöntemdir. Ameliyat sonrası mobilizasyonun hızlı olması dolayısı ile taburculuk süresi ve sosyal hayata dönüş hızlanmaktadır. Bu çalışma sonucunda ameliyat sırasında uygulanan vida sayısı ile hastanede yatış süresi arasında anlamlı bir ilişki bulunmamıştır.

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Brain tumor craniotomy outcomes for dual-eligible medicare and medicaid patients: a 10-year nationwide analysis

et al. 2022

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Hospital competitive intensity and perioperative outcomes following lumbar spinal fusion

Cited by 13 publications

References 18 publications

Interhospital competition and hospital charges and costs for patients undergoing cranial neurosurgery

Interhospital competition and hospital charges and costs for patients undergoing cranial neurosurgery

The Relationship Between Screws Number and Length of Stay in Transpedicular Fixation Surgery

Brain tumor craniotomy outcomes for dual-eligible medicare and medicaid patients: a 10-year nationwide analysis

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