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Fewer screws in treatment of adolescent idiopathic scoliosis may reduce cost and increase safety
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Researchers found a reduction in the number of screws by 3.2 per patient undergoing surgery for adolescent idiopathic scoliosis could decrease national adolescent idiopathic scoliosis hospitalization costs by up to 7%.
Researchers used a medical decision model with sensitivity analysis to analyze the potential cost savings of using fewer pedicle screws in adolescent idiopathic scoliosis (AIS) surgery. The researchers conducted a descriptive analysis and explored annual costs for 5,710 AIS inpatient stays using discharge data from the 2009 Kids’ Inpatient Database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), a national all-payer inpatient database. The total cost for the inpatient AIS stays was $278 million in 2009, which represents a cost of $48,900 per patient.
Researchers assumed all inpatient stays represented 10-level fusions with pedicle screws for AIS, with high screw density defined as 1.8 screws per levels and standard screw density defined as 1.48 screws per levels fused. Researchers estimated that changing from high-density screws to a standard pattern would result in $10 million to $18 million in health care savings from implant costs.
“By including the costs of the predicted 21 to 88 averted surgical returns due to malpositioned screws, this would reduce costs by $11 million to $20 million annually. This would effectively reduce the total U.S. cost of AIS surgery by 4% to 7%. If even fewer screws were used, this would obviously result in greater potential cost savings,” researchers wrote in the study.
Researchers noted additional research is needed to determine whether low implant density screws can provide equivalent results. – by Robert Linnehan
Disclosures: Larson reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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