Study: Reducing variability in spine surgery can likely save millions of dollars

A cost variance study conducted by investigators at Emory University found the institution could save upwards of $3 million a year if it homogenized its practices and developed standard protocols for spine surgery.

At the American Association of Neurological Surgeons (AANS) Annual Meeting, here, Daniel Refai, MD, Assistant Professor of Neurosurgery and Orthopaedic Surgery, Emory Orthopaedic and Spine Center, Atlanta, and Associated Editor, Neurosurgery, of Spine Surgery Today, presented the study’s findings, which showed surgeon preference directly impacted the cost of spine surgery.

Daniel Refai

“We are on target to save $3 million this year. If you look at our data set, 66% of the total cost variance in the surgical care for any patient is at the level of the operating room. More importantly, 92% of that 66% variance is at the level of the individual, and that is you, that is the surgeon. For us, that 92% came down to preference. It came down to interbody spacers used, the type of spinal implantation or instruments and the bone grafting material,” Refai told Spine Surgery Today.

Refai and colleagues used an Emory University administrative database and analyzed 3,538 patients who underwent surgical spine procedures using diagnosis-related groups (DRGs). The investigators also analyzed 2,891 patients for whom current-procedural terminology (CPT)-related data were available.

Using a generalized linear model of regression, they looked at procedures and the related cost centers to determine inter-cost variability. The investigators identified 13 DRGs in spine surgery and 31 CPT-based procedure categories of interest.

The subgroup analysis of the CPT-based procedures which had high inter-group variability showed that 66% of the variability occurred in the OR.

“More interestingly, 92% of that 66% is basically in our hands as individual surgeons, so we make up a huge component of variability,” Refai said.

The highest degree of variability in a spinal procedure is surgeon preference; specifically the type of interbody spacers, the type of spinal implantation or instruments and the type of bone graft material used, according to the results.

The cost of the same procedures performed by different surgeons may vary from $4,000 to $12,000, depending on these variables, Refai noted.

“Among the group of 14 surgeons (both private and academic orthopedic spine surgeons and neurosurgeons at Emory Healthcare), we are going to be able to develop standard protocols and homogenize our practice, and by doing so we can offer a solution for our patients that is more in line with our partners’, more in line with the literature, and at the same time reducing the cost to the patients, the insurer and the hospital,” he said.

The final numbers will be available later this year during the second phase of the study, but Emory University is estimated to save $3 million by using these cost-saving methods, according to Refai. – by Robert Linnehan

Reference:
Baum RG, et al. Paper #826. Presented at: American Association of Neurological Surgeons Annual Meeting; May 2-6, 2015; Washington, D.C.

For more information:
Daniel Refai, MD, can be reached at Emory Orthopaedic and Spine Center, Emory Ortho & Spine Center, 59 Executive Park South, Suite 3000, Atlanta, GA 30329; email: daniel.refai@emory.edu.

Disclosure: Refai reports he receives royalties from Aesculap, Zimmer Biomet and receives honoraria from DePuy Synthes, Medtronic and Stryker.