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Spine Surgeon Treatment Variability: The Impact on Costs.

Matthew D Alvin1, Daniel Lubelski2, Ridwan Alam3

  • 1Department of Radiology, The Johns Hopkins Hospital, Baltimore, MD, USA.

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|September 28, 2018
PubMed
Summary

Spine surgeon costs vary significantly for similar lumbar spine conditions. Factors like surgeon experience and practice type influence treatment expenses, highlighting a need for cost-effective care strategies.

Keywords:
degenerative disc diseasedisc herniationlumbar interbody fusion

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Area of Science:

  • Orthopedics
  • Neurosurgery
  • Health Economics

Background:

  • Limited evidence and guidelines for lumbar spine disease treatment lead to varied surgical approaches.
  • Variability in surgical treatments is associated with differing costs for managing spinal pathologies.

Purpose of the Study:

  • To investigate national cost variations among spine surgeons for treating identical lumbar spine pathologies in similar patients.
  • To identify factors contributing to cost differences in surgical interventions for spinal conditions.

Main Methods:

  • Cross-sectional analysis of survey data from 445 spine surgeons.
  • Surgeons provided treatment decisions for clinical scenarios involving recurrent lumbar disc herniation, low back pain, and spondylolisthesis.
  • Treatment costs were estimated using Medicare national payment amounts.

Main Results:

  • For recurrent lumbar disc herniation, surgeon volume and experience impacted costs, with lower-volume and less experienced surgeons incurring higher expenses.
  • Academic surgeons treating low back pain had substantially lower costs (55%) than private practice surgeons.
  • Spondylolisthesis treatment showed significant variability but no significant cost differences.

Conclusions:

  • Substantial variability exists in surgical treatment strategies for various lumbar spine pathologies.
  • Understanding the drivers of treatment selection variability is crucial for optimizing cost-effective spine care delivery.