Researchers analyzed the costs associated with various spine and orthopedic surgery adverse events, according to a study published in Journal of Neurosurgery: Spine. Since payers are not responsible for "never events," hospitals must bear the financial responsibility of these complications.
The study involved the California State Inpatient Database from 2008 to 2009. The researchers examined patients undergoing anterior cervical discectomy and fusion, posterior lumbar interbody fusion, lumbar laminectomy, total knee replacement and total hip replacement.
The researchers separated patients with complication codes — surgical site infection, deep vein thrombosis and pulmonary embolism — from those patients who did not have those complications.
Here are six observations:
1. The ACDF group had the least number of adverse events:
- DVT — 0.6 percent
- PE — 0.1 percent
- SSI — 0.03 percent
2. The TKA group had the highest number of adverse events:
- DVT — 1.3 percent
- PE — 0.3 percent
- SSI — 0.6 percent
3. Median inpatient charges for procedures without complications ranked as follows:
- Lumbar laminectomy — $51,817
- TKR — $70,116
- ACDF — $73,432
- THR — $74,459
- PLIF — $143,601
4. Procedures with DVT complication code charges ranged from:
- TKR — $108,387
- ACDF — $313,536
5. Procedures with PE complication code charges ranged from:
- TKR — $127,958
- PLIF — $246,637
6. Procedures with SSI complication code charges ranged from:
- TKR — $168,964
- PLIF — $ 385,753
The researchers found spinal surgery adverse events significantly increased cost of care. Hospital charges for patients with DVT, PE and SSI spiked between 1.8 and 4.3 times those patients without complications.
"Cost projections by healthcare providers will need to incorporate expected costs of added care for patients experiencing such complications, assuming that the cost burden of such events continues to shift from payers to providers," the researchers concluded in the study.