Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy
Abstract Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could...
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Published in | International journal of spine surgery Vol. 7; no. 1; pp. e72 - e80 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
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Elsevier Inc
01.12.2013
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Abstract | Abstract Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM. Methods We performed a retrospective review of 81 consecutive patients from a single institution; 55 patients were treated with CLP and 26 with CLF. CLP was performed via the double-door allograft technique that does not require implants, whereas laminectomy fusion procedures included metallic instrumentation. We analyzed 10,682 individual costs (HC) and charges (HCh) for all patients, as obtained from hospital accounting data. The Current Procedural Terminology codes were used to estimate the physicians' fees as such fees are not accounted for via hospital billing records. Total cost (TC) therefore equaled the sum of the hospital cost and the estimated physicians' fees. Results The mean length of stay was 3.7 days for CLP and 5.9 days for CLF ( P < .01). There were no significant differences between the groups with respect to age, gender, previous surgical history, and medical insurance. The TC mean was $17,734 for CLP and $37,413 for CLF ( P < .01). Mean HCh for CLP was 42% of that for CLF, and therefore the mean charge for CLF was 238% of that for CLP ( P < .01). Mean HC was $15,426 for CLP and $32,125 for CLF ( P < .01); the main contributor was implant cost (mean $2582). Conclusions Our study demonstrates that, in clinically similar populations, CLP results in reduced length of stay, TC, and hospital charges. In CSM cases requiring posterior decompression, we demonstrate CLP to be a less costly procedure. However, in the presence of neck pain, kyphotic deformity, or gross instability, this procedure may not be sufficient and posterior CLF may be required. |
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AbstractList | Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM.
We performed a retrospective review of 81 consecutive patients from a single institution; 55 patients were treated with CLP and 26 with CLF. CLP was performed via the double-door allograft technique that does not require implants, whereas laminectomy fusion procedures included metallic instrumentation. We analyzed 10,682 individual costs (HC) and charges (HCh) for all patients, as obtained from hospital accounting data. The Current Procedural Terminology codes were used to estimate the physicians' fees as such fees are not accounted for via hospital billing records. Total cost (TC) therefore equaled the sum of the hospital cost and the estimated physicians' fees.
The mean length of stay was 3.7 days for CLP and 5.9 days for CLF (P < .01). There were no significant differences between the groups with respect to age, gender, previous surgical history, and medical insurance. The TC mean was $17,734 for CLP and $37,413 for CLF (P < .01). Mean HCh for CLP was 42% of that for CLF, and therefore the mean charge for CLF was 238% of that for CLP (P < .01). Mean HC was $15,426 for CLP and $32,125 for CLF (P < .01); the main contributor was implant cost (mean $2582).
Our study demonstrates that, in clinically similar populations, CLP results in reduced length of stay, TC, and hospital charges. In CSM cases requiring posterior decompression, we demonstrate CLP to be a less costly procedure. However, in the presence of neck pain, kyphotic deformity, or gross instability, this procedure may not be sufficient and posterior CLF may be required. BACKGROUNDCervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM. METHODSWe performed a retrospective review of 81 consecutive patients from a single institution; 55 patients were treated with CLP and 26 with CLF. CLP was performed via the double-door allograft technique that does not require implants, whereas laminectomy fusion procedures included metallic instrumentation. We analyzed 10,682 individual costs (HC) and charges (HCh) for all patients, as obtained from hospital accounting data. The Current Procedural Terminology codes were used to estimate the physicians' fees as such fees are not accounted for via hospital billing records. Total cost (TC) therefore equaled the sum of the hospital cost and the estimated physicians' fees. RESULTSThe mean length of stay was 3.7 days for CLP and 5.9 days for CLF (P < .01). There were no significant differences between the groups with respect to age, gender, previous surgical history, and medical insurance. The TC mean was $17,734 for CLP and $37,413 for CLF (P < .01). Mean HCh for CLP was 42% of that for CLF, and therefore the mean charge for CLF was 238% of that for CLP (P < .01). Mean HC was $15,426 for CLP and $32,125 for CLF (P < .01); the main contributor was implant cost (mean $2582). CONCLUSIONSOur study demonstrates that, in clinically similar populations, CLP results in reduced length of stay, TC, and hospital charges. In CSM cases requiring posterior decompression, we demonstrate CLP to be a less costly procedure. However, in the presence of neck pain, kyphotic deformity, or gross instability, this procedure may not be sufficient and posterior CLF may be required. Abstract Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM. Methods We performed a retrospective review of 81 consecutive patients from a single institution; 55 patients were treated with CLP and 26 with CLF. CLP was performed via the double-door allograft technique that does not require implants, whereas laminectomy fusion procedures included metallic instrumentation. We analyzed 10,682 individual costs (HC) and charges (HCh) for all patients, as obtained from hospital accounting data. The Current Procedural Terminology codes were used to estimate the physicians' fees as such fees are not accounted for via hospital billing records. Total cost (TC) therefore equaled the sum of the hospital cost and the estimated physicians' fees. Results The mean length of stay was 3.7 days for CLP and 5.9 days for CLF ( P < .01). There were no significant differences between the groups with respect to age, gender, previous surgical history, and medical insurance. The TC mean was $17,734 for CLP and $37,413 for CLF ( P < .01). Mean HCh for CLP was 42% of that for CLF, and therefore the mean charge for CLF was 238% of that for CLP ( P < .01). Mean HC was $15,426 for CLP and $32,125 for CLF ( P < .01); the main contributor was implant cost (mean $2582). Conclusions Our study demonstrates that, in clinically similar populations, CLP results in reduced length of stay, TC, and hospital charges. In CSM cases requiring posterior decompression, we demonstrate CLP to be a less costly procedure. However, in the presence of neck pain, kyphotic deformity, or gross instability, this procedure may not be sufficient and posterior CLF may be required. |
Author | Goldstein, Jeffrey A., MD Andres, Tate M., BS Hoelscher, Christian M., BS Bendo, John A., MD Ricart-Hoffiz, Pedro A., MD Protopsaltis, Themistocles S., MD Warren, Daniel T., MD |
AuthorAffiliation | a Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada b Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY c Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY |
AuthorAffiliation_xml | – name: c Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY – name: b Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY – name: a Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada |
Author_xml | – sequence: 1 fullname: Warren, Daniel T., MD – sequence: 2 fullname: Ricart-Hoffiz, Pedro A., MD – sequence: 3 fullname: Andres, Tate M., BS – sequence: 4 fullname: Hoelscher, Christian M., BS – sequence: 5 fullname: Protopsaltis, Themistocles S., MD – sequence: 6 fullname: Goldstein, Jeffrey A., MD – sequence: 7 fullname: Bendo, John A., MD |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25694907$$D View this record in MEDLINE/PubMed |
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Copyright | ISASS – The International Society for the Advancement of Spine Surgery 2013 ISASS – The International Society for the Advancement of Spine Surgery 2013 ISASS - The International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved. 2013 |
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Keywords | Hospital cost Cervical laminectomy and fusion Cervical laminoplasty Cost comparison |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Goldstein, Jeffrey A.: Private Investments, K2M; Physician Fellowship Partners, Spinecore; Consulting, Synthes Spine, NuVasive, Medtronic, K2M; Speaking or Teaching Arrangements or both, Synthes Spine; Trips/Travel, Synthes Spine (Financial, Reimbursement for travel to teach); Scientific Advisory Board, Pearl Diver; Research Support—Staff or Materials or both, Axiomed (paid directly to institution/employer); Fellowship Support, Medtronic (paid directly to institution/employer), Synthes Spine (paid directly to institution/employer). Support for this study was obtained through departmental funding within an academic institution. Drs. Bendo and Goldstein maintain relationships within the medical industry for the advancement of the field; their full financial disclosures are listed below. Bendo, John A.: Consulting, Synthes Spine. |
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Snippet | Abstract Background Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the... Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical... BACKGROUNDCervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of... |
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SubjectTerms | Cervical laminectomy and fusion Cervical laminoplasty Cost comparison Full Length Hospital cost Orthopedics Surgery |
Title | Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy |
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