Perioperative Spending on Spinal Fusion for Scoliosis for Children With Medical Complexity

Berry, Jay G.; Glotzbecker, Michael; Rodean, Jonathan; Leahy, Izabela; Cox, Joanne E.; Singer, Sara J.; O’Neill, Margaret; Hall, Matt; Ferrari, Lynne R.

doi:10.1542/peds.2017-1233

Cited by 23 publications

(33 citation statements)

References 28 publications

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“…It is imperative that pediatricians consider these findings because they can be used to help address preoperative active health issues and guide both surgical and anesthesiology providers when determining whether it is safe to proceed with surgery. [5][6][7][8][9] Beyond active health issues identified preoperatively, the current study is also the first to quantify the interaction of CCCs and polypharmacy with the likelihood of PoPD. In CART analysis, this interaction was the strongest predictor of PoPD for pediatric patients undergoing higher-risk surgeries (eg, spinal fusion for neuromuscular scoliosis); the likelihood of PoPD increased by over one-third in patients with a CCC when they used 11 or more chronic medications.…”

Section: Discussionmentioning

confidence: 99%

“…4 With the advent of the medical home, general pediatricians increasingly participate in preoperative evaluations. [5][6][7][8][9] Ideally during the preoperative evaluation, anesthesiologists, surgeons, general pediatricians, and other providers collaborate and assess the current state of a child's health through chart review, patient and family interview, physical examination, and laboratory and radiographic testing. 10,11 The providers identify, discuss, and address active health issues that could compromise patients' perioperative health and safety.…”

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confidence: 99%

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Predicting Postoperative Physiologic Decline After Surgery

Berry

Johnson

Crofton³

et al. 2019

Pediatrics

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BACKGROUND: Projecting postoperative recovery in pediatric surgical patients is challenging. We assessed how the patients' number of complex chronic conditions (CCCs) and chronic medications interacted with active health issues to influence the likelihood of postoperative physiologic decline (PoPD). METHODS: A prospective study of 3295 patients undergoing elective surgery at a freestanding children's hospital. During preoperative clinical evaluation, active health problems, CCCs, and medications were documented. PoPD (compromise of cardiovascular, respiratory, and/or neurologic systems) was measured prospectively every 4 hours by inpatient nurses. PoPD odds were estimated with multivariable logistic regression. Classification and regression tree analysis distinguished children with the highest and lowest likelihood of PoPD. RESULTS: Median age at surgery was 8 years (interquartile range: 2-15); 2336 (70.9%) patients had a CCC; and 241 (7.3%) used $11 home medications. During preoperative evaluation, 1556 (47.2%) patients had $1 active health problem. After surgery, 882 (26.8%) experienced PoPD. The adjusted odds of PoPD were 1.2 (95% confidence interval [CI]: 1.0-1.4) for presence versus absence of an active health problem; 1.4 (95% CI: 1.0-1.9) for $11 vs 0 home medications; and 2.2 (95% CI: 1.7-2.9) for $3 vs 0 CCCs. In classification and regression tree analysis, the lowest rate of PoPD (8.6%) occurred in children without an active health problem at the preoperative evaluation; the highest rate (57.2%) occurred in children with a CCC who used $11 home medications. CONCLUSIONS: Greater than 1 in 4 pediatric patients undergoing elective surgery experienced PoPD. Combinations of active health problems at preoperative evaluation, polypharmacy, and multimorbidity distinguished patients with a low versus high risk of PoPD.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Predicting Postoperative Physiologic Decline After Surgery

Berry

Johnson

Crofton³

et al. 2019

Pediatrics

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“…We defined our preoperative time period in accordance with a previous similar study that used this time period per CMS’ bundling norms. 11 The postoperative time period was chosen based on our clinical experience to encompass the full postoperative period and allow us to assess resource utilization (imaging, injections, physical therapy, and narcotics) during the time period. We specifically assessed gross health care perioperative payments on outpatient health services, prescription pain medication, hospital admission (including ACDF surgery) and postoperative all cause hospital readmissions (within 6 months).…”

Section: Methodsmentioning

confidence: 99%

“… 2 - 7 With increased focus on high-value care in the United States, novel payments models such as bundled payments are gaining popularity. 8 - 11 Thus, it has become increasingly important to understand the consumption of health care resources and associated costs of care for the care continuum.…”

Section: Introductionmentioning

confidence: 99%

Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology

Marrache

Harris

Puvanesarajah

et al. 2020

Global Spine Journal

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Study Design: Retrospective review of an administrative database. Objectives: The aim of our study was to investigate the distribution of spending for the entire episode of care among nonelderly, commercially insured patients undergoing elective, inpatient anterior cervical discectomy and fusion (ACDF) surgeries for degenerative cervical pathology. Methods: Using a private insurance claims database, we identified patients who underwent single-level, inpatient ACDF for degenerative spinal disease. Patients were selected using a combination of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes. Entire episode of care was defined as 6-months before (preoperative) to 6 months after (postoperative) the surgical admission. Results: In our cohort containing 33 209 patients, perioperative median spending per patient (MSPP) within the year encompassing surgery totaled $37 020 (interquartile range [IQR] $28 363-$49 206), with preoperative, surgical admission, and postoperative spending accounting for 9.8%, 80.7%, and 9.5% of total spending, respectively. Preoperatively, MSPP was $3109 (IQR $1806-$5215), 48% of patients underwent physical therapy, and 31% underwent injections in the 6 months period prior to surgery. Postoperatively, MSPP was $1416 (IQR $398-$3962), and unplanned hospital readmission (6% incidence) accounted for 33% of the overall postoperative spending. Discharge to a nonhome discharge disposition was associated with higher postoperative spending ($14 216) compared with patients discharged home ($1468) and home with home care ($2903), P < .001. Conclusion: Understanding the elements and distribution of perioperative spending for the episode of care in patients undergoing ACDF surgery for degenerative conditions is important for health care planning and resource allocation.

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“…General pediatrics involvement in preoperative care for children undergoing some surgeries, including spinal fusion for scoliosis, has been associated with increased attention and recommendations for the management of coexisting conditions (Rappaport et al, 2013b). This involvement has also been associated with shorter length of stay and decreased cost for the inpatient episode of care (Berry et al, 2017a; Rappaport et al, 2013a).…”

Section: Introductionmentioning

confidence: 99%

Pediatric complex care and surgery comanagement: Preparation for spinal fusion

Berry

Glaspy

Eagan

et al. 2019

J Child Health Care

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The aim of this study is to assess the impact of preoperative comanagement with complex care pediatricians (CCP) on children with neuromuscular scoliosis undergoing spinal fusion. We performed chart review of 79 children aged 5–21 years undergoing spinal fusion 1/2014–6/2016 at a children’s hospital, with abstraction of clinical documentation from preoperative health evaluations performed regularly by anesthesiologists and irregularly by a CCP. Preoperative referrals to specialists, labs, tests, and care plans needed last minute for surgical clearance were measured. The mean age at surgery was 14 (SD 3) years; cerebral palsy (64%) was the most common neuromuscular condition. Thirty-nine children (49%) had a preoperative CCP evaluation a median 63 days (interquartile range (IQR) 33–156) before the preanesthesia visit. Children with CCP evaluation had more organ systems affected by coexisting conditions than children without an evaluation (median 11 (IQR 9–12) vs. 8 (IQR 5–11); p < .001). The rate of last-minute care coordination activities required for surgical clearance was lower for children with versus without CCP evaluation (1.8 vs. 3.6). A lower percentage of children with CCP evaluation required last-minute development of new preoperative plans (26% vs. 50%, p = .002). Children with CCP involvement were better prepared for surgery, requiring fewer last-minute care coordination activities for surgical clearance.

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Perioperative Spending on Spinal Fusion for Scoliosis for Children With Medical Complexity

Cited by 23 publications

References 28 publications

Predicting Postoperative Physiologic Decline After Surgery

Predicting Postoperative Physiologic Decline After Surgery

Health Care Resource Utilization in Commercially Insured Patients Undergoing Anterior Cervical Discectomy and Fusion for Degenerative Cervical Pathology

Pediatric complex care and surgery comanagement: Preparation for spinal fusion

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