A new study published in the Journal of Bone and Joint Surgery examines how readmissions increase the total cost of care for spinal deformity surgery.
The study authors examined records from 659 patients who underwent adult spinal deformity surgery at a single center from 2005 to 2013. The costs are expressed in 2010 dollars. Study authors found:
1. The readmission rates were 24 percent overall, and cost around $10.1 million for the population studied.
2. Around 8.8 percent of the admissions occurred within the first 30 days after surgery, accounting for $3.2 million, and 11.7 percent of the readmissions occurred within the first 90 days, accounting for $4.6 million.
3. Pseudarthrosis was the most expensive readmission, costing around $92,755; infections and kyphosis were also expensive readmissions, costing around $75,172 and $66,713 respectively. As a result, the complications increased the average readmission cost by:
• Pseudarthrosis: 105 percent
• Infection: 72 percent
• Proximal junctional kyphosis: 63 percent
These three complications represented 73 percent of the costs for readmission.
4. Two years after surgery, the average readmission cost was $86,081.
5. The factors associated with increased risk for readmission include:
• Older age
• Eight or more levels fused
• Longer length of index stay at the hospital
6. The researchers reported patients who underwent thoracic only curve or double curve procedures and those who had an anterior-only or posterior-only approach were associated with lower costs.
"Although reducing the 30-day and 90-day readmission rates and costs are important, adult spinal deformity surgery is unique, because the most common and most expensive complications occur after one year," concluded the study authors.