Surgical treatment of posttraumatic spinal cord tethering and syringomyelia: a retrospective cohort investigation of cost, reimbursement, and financial sustainability

Abstract

Background: Posttraumatic spinal cord tethering and syringomyelia are considered disabling diseases in patients with spinal cord injury. In symptomatic patients, surgical management can achieve promising clinical outcomes. As the raising economic pressure might jeopardize optimal and thus personalized patient care, we aimed to exemplify expenses of surgical treatment in contrast to reimbursement by the Swiss diagnosis related group (DRG) system.

Methods: This retrospective investigation includes 60 patients who underwent surgery for spinal cord tethering and syringomyelia. The duration of surgeries was used to estimate the costs of care in the operating room (OR) considering established bench marks. Coverage of costs was calculated by comparing Swiss DRG reimbursements with the expenses from the investigated cases.

Results: The mean duration of surgeries was 251.0 ± 93.5 min while 2.8 ± 1.4 vertebral segments were treated by spinal cord untethering. The mean OR costs (in USD) were $9,401.2±$3,500.2 (range $4,119.5 to $20,223.0). The mean reimbursement and the ratio of OR costs to reimbursement (in USD) were $24,122.5±$7,409.3 (range $17,249.8 to $31,977.1) and 0.41 ± 0.15 (range 0.14 to 0.74) for standard, and $39,106.0±$4,028.6 (range $35,369.1 to $43,376.8) and 0.24 ± 0.08 (range 0.10 to 0.47) for complex cases, respectively. The estimated costs of surgeries were different from reimbursements (p = 0.005).

Conclusions: Although the cost of surgical management of patients with posttraumatic spinal cord tethering and syringomyelia are principally covered, it remains questionable if total hospital expenses are sufficiently outweighed by the current reimbursement system. This could potentially limit the availability of best medical care and might endanger personalized patient management.

Keywords: Diagnosis related groups; Economic; Personalized care; Posttraumatic; Spinal cord tethering; Syringomyelia.

Fig. 1

Absolute expenses and reimbursement for surgically treated spinal cord tethering and syringomyelia. Lower mean operating room cost (OR cost min), mid-situated mean OR cost (OR cost mid), and upper mean OR cost (OR cost max) including reimbursement of standard diagnosis related group (standard DRG) and complex DRG are displayed as bar graphs with respective error bars. All the estimated OR costs of care were different from DRG reimbursements (p = 0.005). Operating room, OR; diagnosis related groups, DRG; United States Dollar, USD

Fig. 2

Ratio of operating room (OR) cost of care to DRG reimbursement for the surgical treatment of spinal cord tethering and syringomyelia. Ratio of lower (min), mid-range (mid), an upper (max) OR cost of care to standard DRG reimbursement (A) and complex DRG reimbursement (B). There was a difference between the estimated ratios versus standard and complex DRG reimbursement (p < 0.001). Operating room, OR; diagnosis related groups, DRG