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- Title
Hospital-level variation in hospitalization costs for spinal fusion in the United States.
- Authors
Curry, Joanna; Cho, Nam Yong; Nesbit, Shannon; Kim, Shineui; Ali, Konmal; Gudapati, Varun; Everson, Richard; Benharash, Peyman
- Abstract
Background: With a growing emphasis on value of care, understanding factors associated with rising healthcare costs is increasingly important. In this national study, we evaluated the degree of center-level variation in the cost of spinal fusion. Methods: All adults undergoing elective spinal fusion were identified in the 2016 to 2020 National Inpatient Sample. Multilevel mixed-effect models were used to rank hospitals based on risk-adjusted costs. The interclass coefficient (ICC) was utilized to tabulate the amount of variation attributable to hospital-level characteristics. The association of high cost-hospital (HCH) status with in-hospital mortality, perioperative complications, and overall resource utilization was analyzed. Predictors of increased costs were secondarily explored. Results: An estimated 1,541,740 patients underwent spinal fusion, and HCH performed an average of 9.5% of annual cases. HCH were more likely to be small (36.8 vs 30.5%, p<0.001), rural (10.1 vs 8.8%, p<0.001), and located in the Western geographic region (49.9 vs 16.7%, p<0.001). The ICC demonstrated 32% of variation in cost was attributable to the hospital, independent of patient-level characteristics. Patients who received a spinal fusion at a HCH faced similar odds of mortality (0.74 [0.48–1.15], p = 0.18) and perioperative complications (1.04 [0.93–1.16], p = 0.52), but increased odds of non-home discharge (1.30 [1.17–1.45], p<0.001) and prolonged length of stay (β 0.34 [0.26–0.42] days, p = 0.18). Patient factors such as gender, race, and income quartile significantly impacted costs. Conclusion: The present analysis identified 32% of the observed variation to be attributable to hospital-level characteristics. HCH status was not associated with increased mortality or perioperative complications.
- Subjects
UNITED States; SPINAL fusion; SURGICAL complications; RACE; MULTILEVEL models; HOSPITAL mortality; INTENSIVE care units
- Publication
PLoS ONE, 2024, Vol 19, Issue 2, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0298135