Abstract Background context Over the past decade, the number of Adult Spinal Deformity (ASD) surgeries has more than doubled in the United States. The complex surgeries needed to manage ASD are ...associated with significant resource utilization and high cost making them a primary target for increased scrutiny . Accordingly, it is important to not only demonstrate value in ASD surgery as clinical effectiveness but also to translate outcome assessment to cost-effectiveness. Purpose To compare the difference between Medicare allowable rates and the actual, direct hospital costs for ASD surgeries. Study design Longitudinal cohort Patient sample Consecutive patients enrolled in an ASD database from a single institution Outcome measures Short Form -6D Methods Consecutive patients enrolled in an ASD database from a single institution from 2008–2013 were identified. Direct hospital costs were collected from hospital administrative records for the entire inpatient episode of surgical care. Medicare allowable rates were calculated for the same inpatient stays using the year-appropriate Center for Medicare-Medicaid Services Inpatient Pricer Payment System Tool. The SF-6D, a utility index derived from the SF-36v1, was used to determine quality-adjusted life-years (QALY).Costs and QALYs were discounted at 3.5% annually. Results Of 580 surgical ASD patients eligible for two-year follow up, 346 (60%) had complete baseline and 2-year data, and 60 were Medicare beneficiaries comprising the cohort for this study. Mean SF-6D gained was 0.10 during year one after surgery and 0.02 at year two; resulting in a cumulative SF-6D gain of 0.12 over two years. Mean Medicare allowable rates over the two years was $82,050 (range, $42,383 to $220,749) and mean direct costs were $99,114 (range, $28,447 to $217,717). Mean cost/QALY over two years was $683,750 using Medicare allowable rates $825,950 using direct costs. This difference of $17,181 between the two cost calculation represents a 17% difference, which was statistically significant (p <0.001). Conclusion There is a significant difference in direct hospital costs versus Medicare allowable rates in ASD surgery and in turn, there is a similar difference in the cost/QALY calculation. Utilizing Medicare allowable rates not only underestimates (17%) the cost- of ASD surgery, but it creates inaccurate and unrealistic expectations for researchers and policymakers.
Retrospective cohort.
To determine if the use of cell saver reduces overall blood costs in adult spinal deformity (ASD) surgery.
Recent studies have questioned the clinical value of cell saver during ...spine procedures.
ASD patients enrolled in a prospective, multicenter surgical database who had complete preoperative and surgical data were identified. Patients were stratified into (1) cell saver available during surgery, but no intraoperative autologous infusion (No Infusion group), or (2) cell saver available and received autologous infusion (Infusion group).
There were 427 patients in the Infusion group and 153 in the No infusion group. Patients in both groups had similar demographics. Mean autologous infusion volume was 698 mL. The Infusion group had a higher percentage of EBL relative to the estimated blood volume (42.2%) than the No Infusion group (19.6%, p < .000). Allogeneic transfusion was more common in the Infusion group (255/427, 60%) than the No Infusion group (67/153, 44%, p = .001). The number of allogeneic blood units transfused was also higher in the Infusion group (2.4) than the No Infusion group (1.7, p = .009). Total blood costs ranged from $396 to $2,146 in the No Infusion group and from $1,262 to $5,088 in the Infusion group. If the cost of cell saver blood was transformed into costs of allogeneic blood, total blood costs for the Infusion group would range from $840 to $5,418. Thus, cell saver use yielded a mean cost savings ranging from $330 to $422 (allogeneic blood averted). Linear regression showed that after an EBL of 614 mL, cell saver becomes cost-efficient.
Compared to transfusing allogeneic blood, cell saver autologous infusion did not reduce the proportion or the volume of allogeneic transfusion for patients undergoing surgery for adult spinal deformity. The use of cell saver becomes cost-efficient above an EBL of 614 mL, producing a cost savings of $330 to $422.
Level III.
