Using Intersurgeon Variation to Inform Cost-reduction Strategies in Anterior Cervical Discectomy and Fusion (ACDF)

Authors

Ken Porche, College of Medicine, University of Florida, Gainesville, FL, USA
Sasha Vaziri, College of Medicine, University of Florida, Gainesville, FL, USA
Alan Stein, College of Medicine, University of Florida, Gainesville, FL, USA
Omar Awan, College of Medicine, University of Florida, Gainesville, FL, USA
Brandon Lucke-Wold, College of Medicine, University of Florida, Gainesville, FL, USAFollow
Paul S. Kubilis, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
Paul Lipori, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
Daniel J Hoh, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
Adam Polifka, College of Medicine, University of Florida, Gainesville, FL, USA
W. Christopher Fox, Department of Neurologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA

Corresponding Author

Brandon Lucke-Wold, MD, PhD PO Box 100265 Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32610 Work: 352 273 9000 Fax: 352 392 8413 Email: Brandon.Lucke-Wold@neurosurgery.ufl.edu

Document Type

Original Research - Oncology

Abstract

Background: Inter-surgeon variability is a potential driver of variation in bundled care costs associated with cervical spine surgery.

Objective: This study aims to determine modifiable inter-surgeon factors that predict hospital cost variations associated with anterior cervical discectomy and fusions (ACDF).

Methods: This is a retrospective review of ACDF cases performed at a single institution by 15 surgeons from 2011 to 2017. Univariate analyses and mixed linear regression models were then used with the surgeon as a random effects variable to determine which factors were associated with surgical episode costs and surgical time. Signs and symptoms of cervical myelopathy were collected from clinic notes before and after surgery to determine changes due to surgical intervention.

Results: In this series of 263 ACDF procedures, the average surgical episode direct cost was $16,447±$5,512. Factors associated with significantly increased surgical episode costs include the number of levels (NOL), cage type, length of stay (LOS), surgical time, neuromonitoring, complication occurrence, and unplanned return to the operating room. Factors associated with a significant increase in surgical time include body mass index, NOL, and surgeon experience. Factors associated with improvements in symptomatology included cage type, NOL, surgical time, and neuromonitoring.

Conclusions: The present study examines inter-surgeon methodology variation as a cost driver in patients undergoing ACDF at our institution. Choosing an interbody device and minimizing neuromonitoring may result in cost savings at the expense of potential improvements in patient outcomes.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Recommended Citation

Porche, Ken; Vaziri, Sasha; Stein, Alan; Awan, Omar; Lucke-Wold, Brandon; Kubilis, Paul S.; Lipori, Paul; Hoh, Daniel J; Polifka, Adam; and Fox, W. Christopher (2024) "Using Intersurgeon Variation to Inform Cost-reduction Strategies in Anterior Cervical Discectomy and Fusion (ACDF)," Archives of Neurosurgery: Vol. 3: Iss. 1, Article 1.
DOI: https://doi.org/10.71119/2992-8478.1044
Available at: https://www.ansjournal.org/home/vol3/iss1/1