Lumbar spine arthrodesis. A comparison of hospital costs between 1986 and 1993

The purpose of this project was to evaluate the hospital costs of one- and two-level spinal arthrodesis and to determine areas where costs may be effectively reduced. The hospital bills of 40 patients (20 each in 1986 and 1993) who had undergone single-level and double-level lumbar arthrodesis were reviewed. Each patients's bill was examined and the specific charge items were assigned to one of seven "service centers." To effectively compare costs in the two different years, dollar values on 1986 bills were converted to inflation-adjusted 1993 amounts (the consumer price index over this interval was about 35%). The hospital cost (mean) for single- and double-level spinal arthrodesis increased from $7,457 (1986) to $19,712 (1993). In inflation-adjusted 1993 dollars the actual increase was 97%. All but two service centers demonstrated increased costs. The most dramatically increased in price was implant cost ($300 in 1986 vs $2,967 in 1993, a 638% increase with inflation adjustment). When adjusted for inflation, surgeons' fees actually decreased by 18% at our institution ($7,503 in 1986 vs $8,338 in 1993). The other service center that showed a decrease was the hospital room (-15%). The anesthesia charge, recovery-room fee, operating-room charge, and the "other" charges increased between 36% and 288%. As a percentage of the total hospital bill, implant cost accounted for approximately 4% of the 1986 charges, whereas in 1993 it accounted for more than 15% of the total bill. None of the other service centers showed such a drastic increase. Increasingly sophisticated technology has dramatically raised hospital charges. Strategies to reduce the overall cost of spinal surgery should concentrate on controlling the cost of spinal implants.