Hospital Cost Analysis of Adolescent Idiopathic Scoliosis Correction Surgery in 125 Consecutive Cases

Kamerlink, Jonathan; Quirno, Martin; Auerbach, Joshua D.; Milby, Andrew H.; Windsor, Lynne; Dean, Laura; Dryer, Joseph; Errico, Thomas J.; Lonner, Baron S.

doi:10.2106/jbjs.i.00879

Cited by 102 publications

(53 citation statements)

References 15 publications

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“…12 Assessment of the overall costs, including costs for both initial and revision surgery, may elucidate the true value of all-pedicle screw constructs compared to hybrid constructs. 13 In the present study, when revision surgeries secondary to implant failure were taken into account, the cost for all-pedicle screw constructs was only 7.2% higher than that for hybrid constructs. We also demonstrated greater correction of deformity and durability of correction with decreased revision rates for AIS patients treated with all-pedicle screw constructs as compared to hybrid constructs.…”

Section: Discussionmentioning

confidence: 50%

Are pedicle screw constructs really more expensive than hybrid constructs?

Blumstein

Shan

Lee

et al. 2016

Current Orthopaedic Practice

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Section: Discussionmentioning

confidence: 50%

Are pedicle screw constructs really more expensive than hybrid constructs?

Blumstein

Shan

Lee

et al. 2016

Current Orthopaedic Practice

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“…This represents a cost of $48,900 per patient. If 29% of the surgical costs are secondary to implants, as reported by Kamerlink et al, 24 this represents $81 million dollars spent on implants. Due to the limited data contained in KID, the type and number of implants used are unknown.…”

Section: Resultsmentioning

confidence: 96%

“…All surgeries were assumed to be posterior instrumentation with pedicle screw fixation over 10 fusion levels, which is the commonly reported mean length of AIS fusion (Table 1). 4,8,28,24,26 All spinal fusions were assumed to be carried out exclusively with pedicle screws.…”

Section: Methodsmentioning

confidence: 99%

“…40 With the introduction of pedicle screws, the cost of scoliosis surgery has increased due to high implant expenses, 41 which comprise on average 29% of the total hospital costs incurred during primary scoliosis surgery. 24 Decreasing the number of implants used may lower the surgical implant cost. If low-density constructs are shown to be safe and clinically equivalent to higher density constructs, fewer pedicle screws could be used, which may have significant benefits in terms of surgical efficiency and the effective use of health care resources.…”

mentioning

confidence: 99%

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What would be the annual cost savings if fewer screws were used in adolescent idiopathic scoliosis treatment in the US?

Larson

Polly

Ackerman

et al. 2016

SPI

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OBJECT There is substantial heterogeneity in the number of screws used per level fused in adolescent idiopathic scoliosis (AIS) surgery. Assuming equivalent clinical outcomes, the potential cost savings of using fewer pedicle screws were estimated using a medical decision model with sensitivity analysis. METHODS Descriptive analyses explored the annual costs for 5710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), which is a national all-payer inpatient database. Patients between 10 and 17 years of age were identified using the ICD-9-CM code for idiopathic scoliosis (737.30). All inpatient stays were assumed to represent 10-level fusions with pedicle screws for AIS. High screw density was defined at 1.8 screws per level fused, and the standard screw density was defined as 1.48 screws per level fused. The surgical return for screw malposition was set at $23,762. A sensitivity analysis was performed by varying the cost per screw ($600–$1000) and the rate of surgical revisions for screw malposition (0.117%–0.483% of screws; 0.8%–4.3% of patients). The reported outcomes include estimated prevented malpositioned screws (set at 5.1%), averted revision surgeries, and annual cost savings in 2009 US dollars, assuming similar clinical outcomes (rates of complications, revision) using a standard- versus high-density pattern. RESULTS The total annual costs for 5710 AIS hospital stays was $278 million ($48,900 per patient). Substituting a high for a standard screw density yields 3.2 fewer screws implanted per patient, with 932 malpositioned screws prevented and 21 to 88 revision surgeries for implant malposition averted, and a potential annual cost savings of $11 million to $20 million (4%–7% reduction in the total cost of AIS hospitalizations). CONCLUSIONS Reducing the number of screws used in scoliosis surgery could potentially decrease national AIS hospitalization costs by up to 7%, which may improve the safety and efficiency of care. However, such a screw construct must first be proven safe and effective.

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“…In 2009 more than 200,000 hospitalizations were associated with an International Classification of Diseasese9 discharge diagnosis of ''curvature of the spine,'' representing more than $3.3 billion in hospitalization costs [7]. Cost-effectiveness research is important as we balance the health care costs of patientcentered care with responsible use of societal health care resources [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%