- Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California,
- Department of Neurosurgery, Medical Scientist Training Program, Case Western Reserve University, Cleveland, Ohio,
- Department of Orthopedic Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States.
- Department of UCI Health, University of California, Irvine, UCI Medical Center, Orange, California, United States.
Correspondence Address:
Alvin Y. Chan, Department of Neurological Surgery, University of California, Irvine, UCI Medical Center, Orange, California, United States.
DOI:10.25259/SNI_497_2022
Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Alvin Y. Chan1, Alexander S. Himstead1, Elliot H. Choi2, Zachary Hsu3, Joshua S. Kurtz1, Chenyi Yang1, Yu-Po Lee3, Nitin N. Bhatia3, Chad T. Lefteris4, William C. Wilson4, Frank P. K. Hsu1, Michael Y. Oh1. Cost analysis comparison between anterior and posterior cervical spine approaches. 15-Jul-2022;13:300
How to cite this URL: Alvin Y. Chan1, Alexander S. Himstead1, Elliot H. Choi2, Zachary Hsu3, Joshua S. Kurtz1, Chenyi Yang1, Yu-Po Lee3, Nitin N. Bhatia3, Chad T. Lefteris4, William C. Wilson4, Frank P. K. Hsu1, Michael Y. Oh1. Cost analysis comparison between anterior and posterior cervical spine approaches. 15-Jul-2022;13:300. Available from: https://surgicalneurologyint.com/surgicalint-articles/11723/
Abstract
Background: The costs of cervical spine surgery have steadily increased. We performed a 5-year propensity scoring-matched analysis of 276 patients undergoing anterior versus posterior cervical surgery at one institution.
Methods: We performed propensity score matching on financial data from 276 patients undergoing 1–3 level anterior versus posterior cervical fusions for degenerative disease (2015–2019).
Results: We found no significant difference between anterior versus posterior approaches for hospital costs ($42,529.63 vs. $45,110.52), net revenue ($40,877.25 vs. $34,036.01), or contribution margins ($14,230.19 vs. $6,312.54). Multivariate regression analysis showed variables significantly associated with the lower contribution margins included age (β = −392.3) and length of stay (LOS; β = −1151). Removing age/LOS from the analysis, contribution margins were significantly higher for the anterior versus posterior approach ($17,824.16 vs. $6,312.54, P = 0.01).
Conclusion: Anterior cervical surgery produced higher contribution margins compared to posterior approaches, most likely because posterior surgery was typically performed in older patients requiring longer LOS.
Keywords: Anterior, Cervical spine surgery, Contribution margins, Finances, Posterior, Propensity scoring matched analysis, Revenue
INTRODUCTION
Although comparisons between anterior and posterior cervical surgical approaches due to degenerative disease have been described in the literature, few studies have focused on relative costs.[
MATERIALS AND METHODS
We analyzed the demographic and financial data for 276 patients undergoing anterior (223 patients) versus posterior (53 patients) 1–3 level cervical fusions for spondylosis between 2015 and 2019; circumferential approaches were excluded from the study [
Statistical analysis
The following statistical tests/analyses were utilized in this study: the unpaired t-test, Chi-squared analysis, and propensity scoring for matched cohorts (i.e., including assessment of multiple variables). Stata (StataCorp) was used for propensity score matched analysis, mean, and standard deviations [
RESULTS
There was no significant difference between the two cohorts regarding: age, ASA score, gender, and LOS. The length of stay was over twice as long for the posterior group versus the anterior (4.5 vs. 2.1, P < 0.01). The number of levels involved was significantly higher in the posterior versus the anterior group (2.1 vs. 1.6, P < 0.01). Summary of the key findings for cost of anterior and posterior cervical spine surgical procedures are presented [
Propensity score matching
Utilizing propensity score matching, (i.e., note the original data showed many more anterior [223] than posterior [53] surgical patients), there were 53 patients placed in each group [
DISCUSSION
This single-institution propensity score-matched analysis compared financial data in anterior and posterior spine surgery over 5 years. We found no significant differences in total charges, costs, net revenue, or contribution margins between anterior and posterior approaches. However, after removal of variables associated with the lower contribution margins on multivariate analysis (age and LOS), the anterior group had significantly higher contribution margins than the posterior group ($17,824.16 vs. $6,312.54, P = 0.01). These findings suggest that the lower contribution margins seen in posterior approaches were caused by an older patient population and longer hospital stay. Here, the authors, along with those from many other studies concluded that the decision to perform anterior versus posterior surgery must be made on a case-by-case basis.[
Financial parameters
Financial parameters include costs and charges to the patient and hospital, revenue, and contribution margins. While several studies found lower hospital charges and total payments in anterior approaches,[
Higher costs of posterior cervical fusions
An association between longer LOS and increased costs was observed after posterior cervical surgery in several studies. A study from Washington found posterior fusions had higher total hospital charges ($23,400 vs. $14,300) and longer LOS (4.6 vs. 3.8 days) compared to anterior fusions.[
No significant differences in hospital costs or net revenue for either approach
The present study did not find significant differences in hospital costs or net revenue between anterior versus posterior cervical surgical groups. This may be explained by the smaller sample size or by geographic variation in the costs of spine surgery.[
CONCLUSION
We performed propensity matched scoring and multivariate regression analysis of financial data on 53 patients undergoing anterior versus posterior 1–3 level cervical fusions and found that anterior approaches showed that significantly higher contribution margins compared to posterior surgery after age and length of stay were removed.
Declaration of patient consent
Patients’ consent not required as patients’ identities were not disclosed or compromised.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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