The Cost of Routine Clinic Visits Following Spinal Fusion for Adolescent Idiopathic Scoliosis

The institutional standard follow-up schedule for patients undergoing spinal instrumentation and fusion for adolescent idiopathic scoliosis (AIS) is return to clinic at 6-weeks and 3 months post-procedure for radiographs. COVID-19 prompted a change in this practice and most routine post-op visits were performed virtually during that time. The purpose of this study is to estimate the cost and benefit of in-person visits to inform the relative value of in-person follow-up using data from the year prior to COVID changes.

This was a retrospective study including all patients with AIS who underwent spinal instrumentation and fusion in 2019 by a single surgeon at a tertiary medical center. The cost of radiographs, travel, and parental lost wages associated with follow-up visits at 6-weeks and 3-months were estimated. Transportation costs were estimated by multiplying the distance between home and clinic by the standard IRS travel reimbursement rate ($0.58/mile). Parental lost wages were estimated using the average 2019 US census income for men and women. Each patient's electronic medical record was reviewed to see whether radiographs and physical assessment resulted in any changes in orthopaedic management at each visit.

The sample included 63 patients (75% female, 94% Caucasian) with an average age of 15.22 years. The average round-trip distance traveled was 94.4 miles (range 3.2-476), resulting in an average travel cost of $109.47. The total time spent for a visit (travel, wayfinding and the clinic visit itself) averaged 330 minutes, resulting in an estimated lost parental wage of $125.47. Estimated cost of radiographs at each visit was $693. This combined cost burden totaled $927.94 for each visit, and no changes in management were prompted by clinical or radiographic findings at any of the 126 visits.

COVID-19 presented many new challenges to healthcare, including a necessary increase in virtual healthcare delivery. This study estimated the cost of in-person follow-up visits the year prior to COVID-19. Patients and their families traveled hundreds of miles and spent hundreds of dollars to attend these visits. No changes in clinical management were prompted by findings at these in-person follow-up visits, and implementation of virtual post-operative visits could potentially lead to cost savings for families in these instances. Level of Evidence: III.