Spine surgery is an expensive procedure, but for patients who would benefit from surgical correction the long-term economic benefits can far outweigh the initial cost of care. Especially with new minimally invasive and outpatient spine procedures, the cost of spine surgery has dramatically decreased over the past few years. For example, a November 2013 study published in The Spine Journal showed the direct hospital costs were $19,512 for patients who underwent minimally invasive transforaminal lumbar interbody fusion, compared with $23,550 for the open procedure. A further article published in 2012 in Spine examined the cost and quality-adjusted life year for single-level instrumented posterolateral lumbar fusion for patients with degenerative lumbar spine conditions.
“Compared to other fields of medicine, there continues to be a relative paucity of high-level evidence available to direct the care of patients with spinal conditions,” says Peter Whang, MD, FACS, an Associate Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine in New Haven, Conn. “However, we have been trying to make up for lost time and this is reflected in the quality of research that ahs recently been published. One obvious example is the considerable amount of data derived from the Spine Patient Outcomes Research Trial.”
When surgery is indicated, there are several factors that increase the cost of care for spine surgery patients. Implants and fusion material are a huge expense, along with resource management costs like operative time and length of stay. When patients have poor pain control or experience complications, costs exceed several thousands of dollars for each additional day in the hospital. Electronic medical records make collecting data easier and clinicians can pinpoint the source of negative trends or outliers in their data. One of the biggest opportunities to reduce complications and associated costs is through postoperative pain management.
Improved pain control can have several economic benefits:
• Quicker discharge from the hospital
• Reduced readmissions for acute pain
• Reduced costs for chronic pain treatment
• Improved patient satisfaction scores
• Reduced legal liability
Physicians are beginning to learn the risk factors for complications and anticipating adverse events to aggressively treat patients earlier. “We certainly cannot eliminate complications in spine surgery, but we can hopefully decrease their incidence and mitigate their consequences,” says Dr. Whang. “For the most part, surgeons have recognized the importance of clinical outcomes and strived to incorporate them into their practice.”