The effect of age and body mass index on cost of spinal surgery

Walid, M. Sami; Sanoufa, Mazen; Robinson, Joe Sam

doi:10.1016/j.jocn.2010.07.132

Cited by 12 publications

(8 citation statements)

References 17 publications

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“…This retrospective study of 787 randomly selected patients did describe an interaction between increasing age and BMI to be significant; however, the researchers acknowledged the increased cost of spinal surgery in relation to age and especially BMI as small. 23 The cost differential reported in our study is able to elicit a difference between the total cost of nonfusion procedures with univariate and multivariate analysis. Although not as large as the difference seen in the fusion analysis of Kalanithi et al, this difference is not trivial and points to another facet increasing the burden of degenerative spine disease on obese individuals.…”

Section: Discussionmentioning

confidence: 79%

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

Planchard

Higgins

Mallory

et al. 2015

Global Spine Journal

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Study Design Retrospective case series. Objective To determine the effect of obesity on the resource utilization and cost in 3270 consecutive patients undergoing elective noninstrumented decompressive surgeries for degenerative spine disease at Mayo Clinic Rochester between 2005 and 2012. Methods Groups were assessed for baseline differences (age, gender, and American Society of Anesthesiologists [ASA] classification, procedure type, and number of operative levels). Outcome variables included the transfusion requirements during surgery, the total anesthesia and surgical times, intensive care unit (ICU) admissions, standardized costs, as well as the ICU and hospital length of stay (LOS). Regression analysis was used to evaluate for strength of association between obesity and outcome variables. Results Baseline differences between the groups (nonobese: n = 1,853; obese: n = 1,417) were found with respect to age, ASA class, gender, procedure type, and number of operative levels. After correcting for differences, we found significant associations between obesity and surgical (p < 0.0001) and anesthesia times (p < 0.0001) and hospital LOS (p < 0.0001). Additionally, ICU admission rates (p = 0.02) and requirement for postoperative ventilation (p = 0.048) were significantly higher in obese patients. Finally, mean difference in total cost ($1,632, p < 0.0001) was significantly higher for the obese cohort. Conclusion Obesity is associated with increased resource utilization and cost in patients undergoing a noninstrumented decompressive surgery for degenerative spine disease.

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Section: Discussionmentioning

confidence: 79%

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

Planchard

Higgins

Mallory

et al. 2015

Global Spine Journal

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show abstract

“…However, these results differ from much of the published literature. 6,9,11,16,17,24 In a study of 1082 patients undergoing ACDF, Minhas et al determined that obesity was associated with a $681 increase in direct hospital costs. 11 Interestingly, these authors found no association between obesity and common cost drivers such as increased hospital stay, complications, or operative time.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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“…Finally, cost of living correlated strongly to procedure cost, but not enough to fully explain the cost trends. In addition to cost of living, 2 studies by Walid et al 15 , 16 show an impact of patient comorbidities, age, and body mass index on operative cost as well.…”

Section: Discussionmentioning

confidence: 99%

Spine Surgeon Treatment Variability: The Impact on Costs

Alvin

Lubelski

Alam³

et al. 2017

Global Spine Journal

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Study Design:Cross-sectional analysis.Objectives:Given the lack of strong evidence/guidelines on appropriate treatment for lumbar spine disease, substantial variability exists among surgical treatments utilized, which is associated with differences in costs to treat a given pathology. Our goal was to investigate the variability in costs among spine surgeons nationally for the same pathology in similar patients.Methods:Four hundred forty-five spine surgeons completed a survey of clinical and radiographic case scenarios on patients with recurrent lumbar disc herniation, low back pain, and spondylolisthesis. Those surveyed were asked to provide various details including their geographical location, specialty, and fellowship training. Treatment options included no surgery, anterior lumbar interbody fusion, posterolateral fusion, and transforaminal/posterior lumbar interbody fusion. Costs were estimated via Medicare national payment amounts.Results:For recurrent lumbar disc herniation, no difference in costs existed for patients undergoing their first revision microdiscectomy. However, for patients undergoing another microdiscectomy, surgeons who operated <100 times/year had significantly lower costs than those who operated >200 times/year (P < .001) and those with 5-15 years of experience had significantly higher costs than those with >15 years (P < .001). For the treatment of low back pain, academic surgeons kept costs about 55% lower than private practice surgeons (P < .001). In the treatment of spondylolisthesis, there was significant treatment variability without significant differences in costs.Conclusions:Significant variability in surgical treatment paradigms exists for different pathologies. Understanding why variability in treatment selection exists in similar clinical contexts across practices is important to ensure the most cost-effective delivery of care among spine surgeons.

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The effect of age and body mass index on cost of spinal surgery

Cited by 12 publications

References 17 publications

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

The Impact of Obesity on Perioperative Resource Utilization after Elective Spine Surgery for Degenerative Disease

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Spine Surgeon Treatment Variability: The Impact on Costs

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