Predicting High Surgical Treatment Costs at Primary Spinal Tumor Patients

Abstract

IntroductionSurgical treatment cost of primary spinal tumors -due to the complexity and magnitude of the surgery- can be high. From a healthcare provider perspective being aware of those factors that influence treatment cost is essential for the best hospital resource management. However the impact of the individual patient characteristics on direct medical costs is unknown. Our objective was to identify those preoperative factors that predict a high direct cost at patients with surgically treated primary spinal tumors.Material and MethodsA retrospective micro-costing study was conducted from a healthcare provider perspective. Total cost per patient resulted from the aggregation of inpatient-days costs, ICU days costs, OR time costs (surgery and anesthesiology), medication costs, blood transfusion costs and other material costs, including appropriate allocation of overheads. Patients with primary spinal tumors operated in the National Center for Spinal Disorders between 2011 and 2014 were selected. The prognostic value of ten preoperative factors (dignity, previous surgery, pathological fracture, neurological dysfunction, age, spinal level, ASA score, Charlson Comorbidity Index, BMI, tumor volume) was investigated in linear regression modelling.Results72 surgically treated primary spinal tumor patients were included in the study. Median length of hospital stay was 12 days (3–115), the median ICU treatment was 1.4 days (0–21.7), the median OR time was 2.8 hour (0.4–20.4). Median cost per patient was 3,088.5 € (537.7 € to 21,860.6 €). In the univariate analysis only ASA score, Charlson Comorbidity Index and pathological fracture were not significantly associated with higher cost. The seven significant variables were further assessed in a multivariate model. Dignity, previous surgery, spinal level and tumor volume were associated with high cost and preoperative neurologic dysfunction showed only a trend toward significance (whole model: R=0,69, R2=0,44, df=5, F=12,34 p < 0,001).ConclusionThe present study identifies four predictive variables for high hospital cost related to primary spinal tumor surgery. Malignant tumors, previous surgery, sacral involvement and large tumor volume significantly increase the cost of treatment. This method of cost analysis provides useful insights for resource management in the surgical treatment of spinal tumors.