Surgeon's choices and choice of surgeons influence hospital charges for spinal fusion surgery

Hospital charges for spinal fusion surgery in the upper spine vary considerably—with the surgeon's choice of spinal hardware being the largest source of variation, reports a study in the May 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

The study also shows that costs vary by surgeon, with higher hospital charges for patients treated by certain surgeons. "Both surgeon's choices and the choice of surgeons influenced the total hospital charges for performing spinal fusion," according to the new research, led by Dr. Nancy E. Epstein of The Albert Einstein College of Medicine, Bronx, N.Y.

How Much Do Spinal Surgery Costs Vary—and Why?
Dr. Epstein and colleagues analyzed charges for 102 spinal fusion surgeries performed at a single hospital over a one-year period. They focused on a procedure called single-level anterior cervical discectomy/fusion—surgery to fuse two adjacent vertebrae in the neck. This is an increasingly frequent operation performed in patients with degenerative disk disease in the cervical (neck) portion of the spine.

Total hospital charges varied substantially: from about $27,000 to $129,000. To clarify the reasons for the variations, the researchers broke down costs into different categories and attempted to identify the factors responsible for higher costs in each category.

Like total charges, inpatient hospital charges showed a fivefold variation: from about $15,000 to $77,000. In this category, the greatest source of variation was the number of days spent in the hospital, which ranged from one to eleven. (Most patients stayed only one or two days.)

For surgical charges, the range was even greater—from about $4,000 to $40,000. This tenfold variation was largely related to the surgeon's choice of instrumentation (hardware) for spinal fusion.

Surgeons have a wide range of choices for instrumentation, including combinations of plates and screws and spacers and implants, Dr. Epstein and colleagues explain. "When combined with surgeon's choices for associated supplies…the number of combinations of instrumentation and supplies becomes enormous, along with a large range of associated costs."

Six surgeons performed about three-fourths of the operations. The researchers found that costs were significantly higher for patients operated on by one particular surgeon: average total charges $82,000, compared to $65,000 for the other five surgeons combined. It's not clear why this surgeon's costs were so much higher, although his or her patients spent more time in the hospital: average 4½ days.

"With the rising cost of medical care, it is important to understand the factors contributing to the different total hospital charges for surgical procedures," the researchers write. Previous studies have assessed the outcomes of cervical spinal fusion procedures, but few have looked at variations in cost.

In addition to documenting five- to ten-fold variations in costs, the new study suggests some reasons why costs are higher for some patients than others—including the type of instrumentation chosen by the surgeon as well as the surgeon performing the operation. Dr. Epstein and colleagues conclude, "As society focuses on the rising cost of medical care, spine surgeons can take proactive steps to reduce the total hospital charges associated with [spinal fusion], one of the most commonly performed cervical operations."