Abstract：
BACKGROUND: As value-based health care arrangements gain traction in spine care, understanding the true cost of care becomes critical. Historically, inaccurate cost proxies have been used, including negotiated reimbursement rates or list prices. However, time-driven activity-based costing (TDABC) allows for a more accurate cost assessment, including a better understanding of the primary drivers of cost in 1-level lumbar fusion.
OBJECTIVE: To determine the variation of total hospital cost, differences in characteristics between high-cost and non-high-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion.
METHODS: Retrospective, multicenter (one academic medical center, one community-based hospital), observational study.
METHODS: A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022.
METHODS: Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion.
METHODS: Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and non-high-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost.
RESULTS: The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs.63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs. 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (i.e., incision to close) and total overall cost (ρ: .26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05).
CONCLUSIONS: A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (e.g., implant and technology use). Also, being a \"fast\" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care.
OBJECTIVE: To determine the variation of total hospital cost, differences in characteristics between high-cost and non-high-cost patients, and to identify the primary drivers of total hospital cost in a sample of patients undergoing 1-level lumbar fusion.
METHODS: Retrospective, multicenter (one academic medical center, one community-based hospital), observational study.
METHODS: A total of 383 patients undergoing elective 1-level lumbar fusion for degenerative spine conditions between November 2, 2021 and December 2, 2022.
METHODS: Total hospital cost of care (normalized); preoperative, intraoperative, and postoperative cost of care (normalized); ratio of most to least expensive 1-level lumbar fusion.
METHODS: Patients undergoing a 1-level lumbar fusion between November 2, 2021 and December 2, 2022 were identified at two hospitals (one quaternary referral academic medical center and one community-based hospital) within our health system. TDABC was used to calculate total hospital cost, which was also broken up into: pre-, intra-, and postoperative timeframes. Operating surgeon and patient characteristics were also collected and compared between high- and non-high-cost patients. The correlation of surgical time and cost was determined. Multivariable linear regression was used to determine factors associated with total hospital cost.
RESULTS: The most expensive 1-level lumbar fusion was 6.8x more expensive than the least expensive 1-level lumbar fusion, with the intraoperative period accounting for 88% of total cost. On average. the implant cost accounted for 30% of the total, but across the patient sample, the implant cost accounted for a range of 6% to 44% of the total cost. High-cost patients were younger (55 years [SD: 13 years] vs.63 years [SD: 13 years], p=.0002), more likely to have commercial health insurance (24 out of 38 (63%) vs. 181 out of 345 (52%), p=.003). There was a poor correlation between time of surgery (i.e., incision to close) and total overall cost (ρ: .26, p<.0001). Increase age (RC: -0.003 [95% CI: -0.006 to -0.000007], p=.049) was associated with decreased cost. Surgery by certain surgeons was associated with decreased total cost when accounting for other factors (p<.05).
CONCLUSIONS: A large variation exists in the total hospital cost for patients undergoing 1-level lumbar fusion, which is primarily driven by surgeon-level decisions and preferences (e.g., implant and technology use). Also, being a \"fast\" surgeon intraoperatively does not mean your total cost is meaningfully lower. As efforts continue to optimize patient value through ensuring appropriate clinical outcomes while also reducing cost, spine surgeons must use this knowledge to lead, or at least be active participants in, any discussions that could impact patient care.
摘要：
背景：随着基于价值的医疗保健安排在脊柱护理中获得牵引力，了解护理的真正成本变得至关重要。历史上,使用了不准确的成本代理，包括协商偿还率或标价。然而,基于时间驱动的作业成本法(TDABC)允许更准确的成本评估，包括更好地了解1级腰椎融合术成本的主要驱动因素。
目的：为了确定医院总费用的变化，高成本和非高成本患者之间的特征差异，并在接受1级腰椎融合术的患者样本中确定总住院费用的主要驱动因素。
方法：回顾性，多中心(一个学术医学中心，一家社区医院)，观察性研究。
方法：在2021年11月2日至2022年12月2日期间，共有383名患者因退行性脊柱疾病而接受选择性1级腰椎融合术。
方法：住院总费用（标准化）；术前，术中,和术后护理费用（标准化）；最便宜与最便宜的1级腰椎融合的比率。
方法：在2021年11月2日至2022年12月2日期间，在我们的卫生系统内的两家医院（一家四级转诊学术医疗中心和一家社区医院）确定了接受一级腰椎融合的患者。TDABC用于计算医院总成本，也被分成:前，intra-,和术后时间。还收集了手术外科医生和患者特征，并在高成本和非高成本患者之间进行了比较。确定手术时间和费用的相关性。使用多变量线性回归来确定与总费用相关的因素。
结果：最昂贵的1级腰椎融合比最便宜的1级腰椎融合贵6.8倍，术中期间占总费用的88%。平均而言。植入物成本占总数的30%，但是在病人样本中，植入物成本占总成本的6%至44%。高成本患者较年轻（55岁[SD：13岁]vs.63岁[SD：13岁]，p=0.0002),更有可能拥有商业健康保险(38人中有24人(63%)与345人中有181人（52%），p=0.003)。手术时间之间的相关性较差(即，切口闭合)和总总成本(ρ：0.26，p<0.0001)。增加年龄（RC：-0.003[95%CI：-0.006至-0.000007]，p=0.049)与成本降低相关。当考虑其他因素时，某些外科医生的手术与总费用降低相关(p<0.05)。
结论：1级腰椎融合术患者的总住院费用存在很大差异，这主要是由外科医生级别的决策和偏好驱动的(例如，植入物和技术使用)。此外，在术中成为一名“快速”的外科医生并不意味着你的总成本显着降低。随着努力继续通过确保适当的临床结果来优化患者价值，同时降低成本，脊柱外科医生必须利用这些知识来领导，或者至少是积极的参与者，任何可能影响患者护理的讨论。
目的：为了确定医院总费用的变化，高成本和非高成本患者之间的特征差异，并在接受1级腰椎融合术的患者样本中确定总住院费用的主要驱动因素。
方法：回顾性，多中心(一个学术医学中心，一家社区医院)，观察性研究。
方法：在2021年11月2日至2022年12月2日期间，共有383名患者因退行性脊柱疾病而接受选择性1级腰椎融合术。
方法：住院总费用（标准化）；术前，术中,和术后护理费用（标准化）；最便宜与最便宜的1级腰椎融合的比率。
方法：在2021年11月2日至2022年12月2日期间，在我们的卫生系统内的两家医院（一家四级转诊学术医疗中心和一家社区医院）确定了接受一级腰椎融合的患者。TDABC用于计算医院总成本，也被分成:前，intra-,和术后时间。还收集了手术外科医生和患者特征，并在高成本和非高成本患者之间进行了比较。确定手术时间和费用的相关性。使用多变量线性回归来确定与总费用相关的因素。
结果：最昂贵的1级腰椎融合比最便宜的1级腰椎融合贵6.8倍，术中期间占总费用的88%。平均而言。植入物成本占总数的30%，但是在病人样本中，植入物成本占总成本的6%至44%。高成本患者较年轻（55岁[SD：13岁]vs.63岁[SD：13岁]，p=0.0002),更有可能拥有商业健康保险(38人中有24人(63%)与345人中有181人（52%），p=0.003)。手术时间之间的相关性较差(即，切口闭合)和总总成本(ρ：0.26，p<0.0001)。增加年龄（RC：-0.003[95%CI：-0.006至-0.000007]，p=0.049)与成本降低相关。当考虑其他因素时，某些外科医生的手术与总费用降低相关(p<0.05)。
结论：1级腰椎融合术患者的总住院费用存在很大差异，这主要是由外科医生级别的决策和偏好驱动的(例如，植入物和技术使用)。此外，在术中成为一名“快速”的外科医生并不意味着你的总成本显着降低。随着努力继续通过确保适当的临床结果来优化患者价值，同时降低成本，脊柱外科医生必须利用这些知识来领导，或者至少是积极的参与者，任何可能影响患者护理的讨论。
