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Comorbidities add to length of stay and hospital cost following spinal surgery
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PHILADELPHIA — A study of patients undergoing cervical or lumbar decompression and fusion or lumbar microdiskectomy has revealed that preoperative comorbidities can add up to $11,000 in added hospital costs.
“There is an extraordinary prevalence of chronic disease in our country … and this has substantially impacted the cost of medicine in our country,” said Joe S. Robinson Jr., MD, FACS, of Macon Ga. “[In this study] we attempted to look at the prevalence of comorbidities in spine surgery and assess the impact of these on the length of stay and costs of the surgery.”
Robinson’s comments came during the 78th Annual Meeting of the American Association of Neurological Surgeons, here.
For the investigation, Robinson and colleagues at the Georgia Neurosurgical Institute retrospectively reviewed the cases of 578 patients who underwent anterior cervical discectomy and fusion (ACDF), lumbar microdiskectomy, or lumbar decompression and fusion for degenerative disc disease.
Charlson Comorbidity Index
For the assessment, they compared hospital length of stay data, hospital charges and the Charlson Comorbidity Index Score calculations, which rates different patient comorbidities making them more easily comparable.
Overall, they found that of the 578 patients: 78% of patients had hypertension; 31% high cholesterol; 35% had a history of diabetes mellitus or an elevated glycosylated hemoglobin; 10% a history of hypothyroidism; 20% a history of coronary heart disease; 8% a history of chronic obstructive pulmonary disease; 2.5% of patients had an active malignant disease; 1.6% epilepsy; 1.4% rheumatoid arthritis or lupus erythematosus; 1.4% advanced or chronic renal disease; and 25.4% of all patients were on antidepressants.
According to the study abstract, half of the patients had a Charlson index score of zero, indicating no comorbidities, and 11.30% had a score of 5 or higher.
Added costs
The investigators found that the Charlson Index scores substantially correlated with length of stay (P < .001) and hospital cost (P < .001). They noted the difference in hospital cost was over $11,000 between patients with a Charlson score of zero and those with a Charlson score of greater than or equal to 5 in the lumbar decompression and fusion group.
“In terms of Medicare reimbursement, when there is a major morbidity or complication it doesn’t go up much,” Robinson said. “So there is a tremendous variance between what Medicare is gong to contribute in this situation since the Medicare cost arrangement does not reflect what comorbidities are doing to spine costs.”
Using a regression analysis of the data, the investigators determined that a Charlson Index greater than 5 is a powerful indicator of substantial increased costs of a spine procedure.
“These comorbidities are very common in spine surgery and they seem to have additive impact on length of stay and hospital costs. You can predict how much these added costs will be by using the Charlson Index,” he said.
- Reference:
Walid MS, Robinson ER, Robinson JS, III, Robinson JS, Jr. Comorbidities in Spine Surgery Patients and Impact on Length of Stay and Hospital Cost. Paper #729. Presented at the 78th Annual Meeting of the American Association of Neurological Surgeons. May 1-5, 2010. Philadelphia.
