Cost and clinical outcome of adolescent idiopathic scoliosis surgeries—experience from a nonprofit community hospital

Abstract

Background: Recognition of the variables that drive the cost of adolescent idiopathic scoliosis (AIS) surgeries will help physicians and hospitals to initiate cost-effective measures. The purpose of this study is to analyze the hospital costs and clinical outcome for AIS surgeries. Methods: A total of 6417 individual hospital costs and charges for 42 consecutive AIS surgeries were reviewed. The patients’ demographic, surgical, and radiographic data were recorded. The costs were categorized. The relationships between total costs, categorized costs, and the independent variables were analyzed. Perioperative and postoperative complications were reviewed. Back pain, leg pain, and Oswestry Disability Index scores were obtained. Results: The patients’ mean age was 15 years, and 37 patients were female. Their mean main curve measured 558. A total of 39 patients had posterior-only procedures, and 3 patients had anterior/posterior procedures. The average number of levels fused was 8. The mean hospital charge was $126,284 (range, $76,171–$215,516). The mean hospital cost was $44,126 (range, $23,205–$74,302). The average hospital stay was 5 days, with an average cost per day of $8825. The largest contributors to the overall hospital cost were spinal implants (31%), and surgery department labor cost (23%). Other categoric cost contributors included medical/surgical bed (19%), central supply/operating room supplies (9%), intensive care unit (6%), bone graft (3%), and others. No complications or revision surgeries occurred in these patients. For patients who had back and/or leg pain preoperatively, their back pain visual analog scale scores improved 1.8 points (4.5 versus 2.7 points, P, .05) and their leg pain visual analog scale scores improved 1.5 points (2.1 versus 0.6 points, P, .05). Their Oswestry Disability Index scores improved 6.1 points (17.3 versus 11.2 points, P . 0.05). Conclusions: The hospital cost for AIS surgeries is significant, with spinal implants and surgery department labor being the largest contributors. These are also areas for potential cost-effective measures.