Surgeon choices, and the choice of surgeons, affect total hospital charges for single-level anterior cervical surgery

Abstract

Study design: This retrospective study assessed the total hospital charges for performing 102 single-level anterior cervical discectomy/fusion (1-ADF) procedures performed during a single year at one institution. All cases were in a single diagnosis-related group (DRG) category (473: cervical spine fusion), and used a single Principle Procedure Code (81.02).

Objective: To examine the variations in total hospital charges and to determine the extent to which surgeons affected these charges.

Summary of background data: Little is known about the variability in total hospital charges for performing 1-ADF, and how the surgeon affects these charges.

Methods: In 2008, 15 surgeons performed 102 1-ADF without comorbidities at a single institution. A total of 80 patients exhibited no myelopathy (ICD-9: 722.0), while 22 were myelopathic (ICD-9-CM: 722.71). The total hospital charges (total charges) were divided into in-patient hospital charges (e.g., room charge/length of stay [LOS], diagnostic studies), and surgical charges. Surgical charges were subdivided into operative charges (operating room, anesthesia, recovery room charges), instrumentation charges (plates/screws, spacers/implants), and supply charges (bone graft supplements). In addition, the total hospital charges were analyzed for the 6 surgeons doing 8 or more cases.

Results: The total hospital charges per patient ranged from $26,653 to $129,220 (a factor of 4.8). The in-patient hospital charges, which ranged from $15,113 to $76,687 (a factor of 5.0), were largely influenced by differing LOS (1-11 days). There was also a large variation in surgical charges, which was largely attributable to the surgeon's choice of instrumentation. Instrumentation charges per patient ranged from $4062 to $40,409 (a factor of 10). The average in-patient hospital and surgical charges of 1 of the 6 surgeons clearly exceeded the averages for the others.

Conclusion: Both the surgeon's choice of instrumentation and the choice of surgeons contributed to large- variations in total hospital charges for 102 patients undergoing 1-ADF.