Spine Surgeon Treatment Variability: The Impact on Costs

Matthew D. Alvin, Daniel Lubelski, Ridwan Alam, Seth K. Williams, Nancy A. Obuchowski, Michael P. Steinmetz, Jeffrey C. Wang, Alfred J. Melillo, Amit Pahwa, Edward C. Benzel, Michael T. Modic, Robert Quencer, Thomas E. Mroz

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Design: Cross-sectional analysis. Objectives: Given the lack of strong evidence/guidelines on appropriate treatment for lumbar spine disease, substantial variability exists among surgical treatments utilized, which is associated with differences in costs to treat a given pathology. Our goal was to investigate the variability in costs among spine surgeons nationally for the same pathology in similar patients. Methods: Four hundred forty-five spine surgeons completed a survey of clinical and radiographic case scenarios on patients with recurrent lumbar disc herniation, low back pain, and spondylolisthesis. Those surveyed were asked to provide various details including their geographical location, specialty, and fellowship training. Treatment options included no surgery, anterior lumbar interbody fusion, posterolateral fusion, and transforaminal/posterior lumbar interbody fusion. Costs were estimated via Medicare national payment amounts. Results: For recurrent lumbar disc herniation, no difference in costs existed for patients undergoing their first revision microdiscectomy. However, for patients undergoing another microdiscectomy, surgeons who operated <100 times/year had significantly lower costs than those who operated >200 times/year (P <.001) and those with 5-15 years of experience had significantly higher costs than those with >15 years (P <.001). For the treatment of low back pain, academic surgeons kept costs about 55% lower than private practice surgeons (P <.001). In the treatment of spondylolisthesis, there was significant treatment variability without significant differences in costs. Conclusions: Significant variability in surgical treatment paradigms exists for different pathologies. Understanding why variability in treatment selection exists in similar clinical contexts across practices is important to ensure the most cost-effective delivery of care among spine surgeons.

Original languageEnglish (US)
Pages (from-to)498-506
Number of pages9
JournalGlobal Spine Journal
Volume8
Issue number5
DOIs
StatePublished - Aug 1 2018

Fingerprint

Spine
Costs and Cost Analysis
Spondylolisthesis
Therapeutics
Pathology
Low Back Pain
Surgeons
Private Practice
Medicare
Cross-Sectional Studies
Guidelines

Keywords

  • degenerative disc disease
  • disc herniation
  • lumbar interbody fusion

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Alvin, M. D., Lubelski, D., Alam, R., Williams, S. K., Obuchowski, N. A., Steinmetz, M. P., ... Mroz, T. E. (2018). Spine Surgeon Treatment Variability: The Impact on Costs. Global Spine Journal, 8(5), 498-506. https://doi.org/10.1177/2192568217739610

Spine Surgeon Treatment Variability : The Impact on Costs. / Alvin, Matthew D.; Lubelski, Daniel; Alam, Ridwan; Williams, Seth K.; Obuchowski, Nancy A.; Steinmetz, Michael P.; Wang, Jeffrey C.; Melillo, Alfred J.; Pahwa, Amit; Benzel, Edward C.; Modic, Michael T.; Quencer, Robert; Mroz, Thomas E.

In: Global Spine Journal, Vol. 8, No. 5, 01.08.2018, p. 498-506.

Research output: Contribution to journalArticle

Alvin, MD, Lubelski, D, Alam, R, Williams, SK, Obuchowski, NA, Steinmetz, MP, Wang, JC, Melillo, AJ, Pahwa, A, Benzel, EC, Modic, MT, Quencer, R & Mroz, TE 2018, 'Spine Surgeon Treatment Variability: The Impact on Costs', Global Spine Journal, vol. 8, no. 5, pp. 498-506. https://doi.org/10.1177/2192568217739610
Alvin MD, Lubelski D, Alam R, Williams SK, Obuchowski NA, Steinmetz MP et al. Spine Surgeon Treatment Variability: The Impact on Costs. Global Spine Journal. 2018 Aug 1;8(5):498-506. https://doi.org/10.1177/2192568217739610
Alvin, Matthew D. ; Lubelski, Daniel ; Alam, Ridwan ; Williams, Seth K. ; Obuchowski, Nancy A. ; Steinmetz, Michael P. ; Wang, Jeffrey C. ; Melillo, Alfred J. ; Pahwa, Amit ; Benzel, Edward C. ; Modic, Michael T. ; Quencer, Robert ; Mroz, Thomas E. / Spine Surgeon Treatment Variability : The Impact on Costs. In: Global Spine Journal. 2018 ; Vol. 8, No. 5. pp. 498-506.
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abstract = "Study Design: Cross-sectional analysis. Objectives: Given the lack of strong evidence/guidelines on appropriate treatment for lumbar spine disease, substantial variability exists among surgical treatments utilized, which is associated with differences in costs to treat a given pathology. Our goal was to investigate the variability in costs among spine surgeons nationally for the same pathology in similar patients. Methods: Four hundred forty-five spine surgeons completed a survey of clinical and radiographic case scenarios on patients with recurrent lumbar disc herniation, low back pain, and spondylolisthesis. Those surveyed were asked to provide various details including their geographical location, specialty, and fellowship training. Treatment options included no surgery, anterior lumbar interbody fusion, posterolateral fusion, and transforaminal/posterior lumbar interbody fusion. Costs were estimated via Medicare national payment amounts. Results: For recurrent lumbar disc herniation, no difference in costs existed for patients undergoing their first revision microdiscectomy. However, for patients undergoing another microdiscectomy, surgeons who operated <100 times/year had significantly lower costs than those who operated >200 times/year (P <.001) and those with 5-15 years of experience had significantly higher costs than those with >15 years (P <.001). For the treatment of low back pain, academic surgeons kept costs about 55{\%} lower than private practice surgeons (P <.001). In the treatment of spondylolisthesis, there was significant treatment variability without significant differences in costs. Conclusions: Significant variability in surgical treatment paradigms exists for different pathologies. Understanding why variability in treatment selection exists in similar clinical contexts across practices is important to ensure the most cost-effective delivery of care among spine surgeons.",
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