Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion.

Authors

• J Alex Sielatycki
• Silky Chotai
• Joseph Wick
• Ahilan Sivaganesan
• Clinton J Devin

Publication/Presentation Date

8-1-2018

Abstract

STUDY DESIGN: Retrospective review of prospective patient outcomes and cost data.

OBJECTIVE: To analyze the contribution of surgeon-specific variability in cost and patient-reported outcomes (PROs) to overall variability in anterior cervical discectomy and fusion (ACDF), whereas adjusting for patient comorbidities.

SUMMARY OF BACKGROUND DATA: Cost reduction in surgical care has received increased attention. Patient factors contributing to cost variability in ACDF have been described; however, intersurgeon cost and outcome variability has received less attention in the literature.

METHODS: Adult patients undergoing elective primary ACDF by five different surgeons were analyzed from a prospective registry database. Direct and indirect 90-day costs were compared across each surgeon, along with PROs. Predicted costs were calculated based on patient co-morbidities, and an "observed versus expected" cost differential was measured for each surgeon; this O/E cost ratio was then compared with PROs.

RESULTS: A total of 431 patients were included in the analysis. There were no differences in comorbidities, age, smoking status, or narcotic use. There was significant variation between surgeons in total 90-day costs, as well as variation between each surgeon's observed versus expected cost ratio. Despite these surgeon-specific cost variations, there were no differences in PROs across the participating surgeons.

CONCLUSION: Intersurgeon cost variation in elective ACDF persists even after adjusting for patient comorbidities. There was no apparent correlation between increased surgeon-specific costs and 90-day PROs. These findings show there is opportunity for improvement in inter-surgeon cost variation without compromise in PROs.

LEVEL OF EVIDENCE: 3.

Volume

43

Issue

16

First Page

1125

Last Page

1132

ISSN

1528-1159

Published In/Presented At

Sielatycki, J. A., Chotai, S., Wick, J., Sivaganesan, A., & Devin, C. J. (2018). Intersurgeon Cost Variability in Anterior Cervical Discectomy and Fusion. Spine, 43(16), 1125–1132. https://doi.org/10.1097/BRS.0000000000002589

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

29419721

Department(s)

Administration and Leadership

Document Type

Article