Teaching hospitals linked with more expensive hospital stays for laminectomy, discectomy
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PHOENIX — Lumbar laminectomy or discectomy performed at teaching hospitals was associated with a shorter length of stay and higher costs compared with when these procedures were performed at non-teaching hospitals, according to data presented at the Orthopaedic Research Society Annual Meeting, here.
Against a backdrop of bundled payments for total joint arthroplasty and possible consideration of this type of payment model for some spine procedures, Dean C. Perfetti, MD MPH, and his colleagues analyzed data for patients in the New York Statewide Planning and Research Cooperative System inpatient database to determine the ways in which teaching hospitals and non-teaching hospitals may compete in terms of lumbar laminectomy and discectomy outcomes.
Analyses of the two settings where these procedures were performed showed, “the length of stay is 10.7% less at teaching hospitals. However, the costs were 21.5% higher at $13,500 compared to $11,400 at non-teaching [hospitals],” Perfetti said.
Researchers identified 37,569 patient admissions between January 2009 and September 2014 with the procedural codes of interest. Patients also had a lumbar degenerative condition.
At the time, there were 16 New York academic departments with residents rotating at 39 hospitals and 134 hospitals did not have residency affiliation, Perfetti said, noting they followed patients in the database for 1 year using a unique patient identifier so patients’ costs based on 2019 dollars and their cost-charge ratio could be tracked.
The disposition to skilled nursing facilities or rehabilitation and the 30-day readmission rates did not differ between the two groups, Perfetti said.
“However, when you look at return to the operating room at 30 days, there was a protective effect of teaching status with 31% decreased risk of return to the OR at 30 days. At 90 days, we found this and, again, at 1 year,” he said.
Among the indications identified for return the OR were irrigation and debridement and infection and fusion, all of which occurred at higher rates at the non-teaching hospitals at 30 days and 90 days postoperatively, according to the results.
“[A]t 1 year, the [irrigation and debridement] I and D rate and the fusion rate was also higher at non-teaching hospitals,” Perfetti said. “So, elective laminectomy and discectomy procedures performed at hospitals with teaching departments were characterized by more expensive index hospital stays, decreased length of stay, no difference in 30-day and 90-day all-cost readmission, and a decreased return to the OR at 30 days, 90 days, and 1 year postoperatively.”
The use of a database was a study weakness, he said, because the researchers were unable to determine the number of lumbar levels treated with the index surgery and could not track patients who were readmitted outside of the state. – by Susan M. Rapp
Reference:
Perfetti DC, et al. Paper 129. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 8-11, 2020; Phoenix.
Disclosure: Perfetti reports no relevant financial disclosures.