Increasing Hospital Charges for Adolescent Idiopathic Scoliosis in the United States

Martin, Christopher T.; Pugely, Andrew J.; Gao, Yubo; Mendoza-Lattes, Sergio; Ilgenfritz, Ryan M.; Callaghan, John J.; Weinstein, Stuart L.

doi:10.1097/brs.0000000000000501

Cited by 78 publications

(60 citation statements)

References 20 publications

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“…18 We also examined comorbid conditions in this population and found an increasing trend toward more comorbid conditions in all patients with AIS who underwent corrective surgery. Throughout the 15-year study period, patients who underwent anteroposterior fusion had the greatest number of comorbid conditions, whereas patients who underwent posterior fusions had the fewest such conditions.…”

Section: Discussionmentioning

confidence: 95%

“…12,28 In recent years, instrumented posterior fusion has been performed with greater regularity for the treatment of AIS. 1,14,16,17,[20][21][22] The relative proportion of anterior versus posterior procedures for patients with AIS was previously investigated by Martin et al, 18 who described the rising use of posterior-based techniques as well as the increasing charges associated with inpatient surgical care, although they did not report comorbidity or complication data.…”

mentioning

confidence: 99%

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Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20, 346 patients

Vigneswaran¹,

Grabel²,

Eberson³

et al. 2015

PED

101

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OBJECT Adolescent idiopathic scoliosis (AIS) can cause substantial morbidity and may require surgical intervention. In this study, the authors aimed to evaluate US trends in operative AIS as well as patient comorbidities, operative approach, in-hospital complications, hospital length of stay (LOS), and hospital charges in the US for the period from 1997 to 2012. METHODS Patients with AIS (ICD-9-CM diagnosis codes 737.30) who had undergone spinal fusion (ICD-9-CM procedure codes 81.xx) from 1997 to 2012 were identified from the Kids' Inpatient Database. Parameters of interest included patient comorbidities, operative approach (posterior, anterior, or combined anteroposterior), in-hospital complications, hospital LOS, and hospital charges. RESULTS The authors identified 20, 346 patients in the age range of 0–21 years who had been admitted for AIS surgery in the defined study period. Posterior fusions composed 63.4% of procedures in 1997 and 94.1% in 2012 (r = 0.95, p < 0.01). The mean number of comorbidities among all fusion groups increased from 3.0 in 1997 to 4.2 in 2012 (r = 0.92, p = 0.01). The percentage of patients with complications increased from 15.6% in 1997 to 22.3% in 2012 (r = 0.78, p = 0.07). The average hospital LOS decreased from 6.5 days in 1997 to 5.6 days in 2012 (r = -0.86, p = 0.03). From 1997 to 2012, the mean hospital charges (adjusted to 2012 US dollars) for surgical treatment of AIS more than tripled from $55,495 in 1997 to $177,176 in 2012 (r = 0.99, p < 0.01). CONCLUSIONS Over the 15-year period considered in this study, there was an increasing trend toward using posterior-based techniques for AIS corrective surgery. The number of comorbid conditions per patient and thus the medical complexity of patients treated for AIS have increased. The mean charges for the treatment of AIS have increased, with a national bill over $1.1 billion per year in 2012.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20, 346 patients

Vigneswaran¹,

Grabel²,

Eberson³

et al. 2015

PED

101

View full text Add to dashboard Cite

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“…1 Surgical correction of AIS presents a number of perioperative challenges including effective pain control, management of opioid related side effects, and delay in mobilization. This can result in significant patient morbidity with the potential for prolonged hospitalization and delayed functional recovery at home.…”

Section: Adolescent Idiopathic Scoliosis (Ais)mentioning

confidence: 99%

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

et al. 2016

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BACKGROUND: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS–PSF population. METHODS: We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate. RESULTS: We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway. CONCLUSIONS: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.

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“…This coding definition has been used in previous NIS studies. 35,41,53 To define patients undergoing surgical correction for scoliosis, the extracted cohort was filtered by matching the surgical codes (81.0-81.0x) with the diagnosis. Considering the objective of the study, only adolescent age groups (10-19 years) as defined by the WHO were included in the analysis.…”

Section: Cohort Definitionmentioning

confidence: 99%

“…35 Based on their analysis, the authors depicted an overall trend of substantially increasing hospital charges against a relatively constant rate of surgical utilization. The popularity of pedicle screw-based constructs and innovations in spinal instrumentation has been attributed to the rising charges.…”

Section: Cost Containment and Future Investigationmentioning

confidence: 99%

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

Menger

Kalakoti

Pugely

et al. 2017

Neurosurgical Focus

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OBJECTIVEAdolescent idiopathic scoliosis (AIS) is the most common form of scoliosis. Limited literature exists defining risk factors associated with outcomes during initial hospitalization in these patients. In this study, the authors investigated patient demographics, clinical and hospital characteristics impacting short-term outcomes, and costs in adolescent patients undergoing surgical deformity correction for idiopathic scoliosis. Additionally, the authors elucidate the impact of hospital surgical volume on outcomes for these patients.METHODSUsing the National Inpatient Sample database and appropriate International Classification of Diseases, 9th Revision codes, the authors identified adolescent patients (10–19 years of age) undergoing surgical deformity correction for idiopathic scoliosis during 2001–2014. For national estimates, appropriate weights provided by the Agency of Healthcare Research and Quality were used. Multivariable regression techniques were employed to assess the association of risk factors with discharge disposition, postsurgical neurological complications, length of hospital stay, and hospitalization costs.RESULTSOverall, 75,106 adolescent patients underwent surgical deformity correction. The rates of postsurgical complications were estimated at 0.9% for neurological issues, 2.8% for respiratory complications, 0.8% for cardiac complications, 0.4% for infections, 2.7% for gastrointestinal complications, 0.1% for venous thromboembolic events, and 0.1% for acute renal failure. Overall, patients stayed at the hospital for an average of 5.72 days (median 5 days) and on average incurred hospitalization costs estimated at $54,997 (median $47,909). As compared with patients at low-volume centers (≤ 50 operations/year), those undergoing surgical deformity correction at high-volume centers (> 50/year) had a significantly lower likelihood of an unfavorable discharge (discharge to rehabilitation) (OR 1.16, 95% CI 1.03–1.30, p = 0.016) and incurred lower costs (mean $33,462 vs $56,436, p < 0.001) but had a longer duration of stay (mean 6 vs 5.65 days, p = 0.002). In terms of neurological complications, no significant differences in the odds ratios were noted between high- and low-volume centers (OR 1.23, 95% CI 0.97–1.55, p = 0.091).CONCLUSIONSThis study provides insight into the clinical characteristics of AIS patients and their postoperative outcomes following deformity correction as they relate to hospital volume. It provides information regarding independent risk factors for unfavorable discharge and neurological complications following surgery for AIS. The proposed estimates could be used as an adjunct to clinical judgment in presurgical planning, risk stratification, and cost containment.

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Increasing Hospital Charges for Adolescent Idiopathic Scoliosis in the United States

Abstract: 4.

Cited by 78 publications

References 20 publications

Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20, 346 patients

Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20, 346 patients

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

Adolescent idiopathic scoliosis: risk factors for complications and the effect of hospital volume on outcomes

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