A 1-Year Cost Analysis of Spinal Surgical Procedures in Spain: Neurosurgeons Versus Orthopedic Surgeons

Avellanal, MartÃ­n; Martin-Corvillo, MÃ³nica; Barrigon, Laura; Espi, Manuel Vazquez; Escolar, Clara M Esteban

Abstract

OBJECTIVE
To evaluate the direct costs of various spinal surgical procedures within 1 year of follow-up and to compare the profiles of neurosurgeons and orthopedic surgeons.
METHODS
All spinal procedures performed within a 10-month period in patients covered by a private insurance company were included. Costs related to the spinal interventions were systematically registered in the company database. Associated costs during the 1-year follow-up were recorded.
RESULTS
In total, 1,862 patients were included, with a total cost of â‚¬11,050,970, of whom 34.8% underwent noninstrumented lumbar decompression (â‚¬3,473), 27.1% dorsolumbar instrumented fusion (â‚¬6,619), 14.6% nucleoplasty (â‚¬1,323), 13.5% cervical surgery (â‚¬4,463), 3.4% kyphoplasty (â‚¬4,200), 2.9% scoliosis (â‚¬15,414), 1.2% oncologic surgery (â‚¬5,590), 0.5% traumatic compression (â‚¬7,844), and 4.7% (â‚¬1,343) other minor interventions (mainly rhizotomies). Approximately 42% of patients required reinterventions within the first year, with a global extra cost of â‚¬7,280,073; 11% were referred to the pain clinic, with a â‚¬114,663 cost; 55.5% were men; and the most common age range of patients who received an intervention was 65-75 years. Neurosurgeons performed 60% of all interventions. Noninstrumented lumbar operations were performed by neurosurgeons twice as often as instrumented operations, and they performed 76% of cervical operations. Orthopedic surgeons performed 2.5 times more instrumented than noninstrumented lumbar operations, and almost all scoliosis and rhizotomy procedures.
CONCLUSION
The direct costs of spinal surgery in Spain were generally lower than those reported in other European Union countries and the United States. Neurosurgeons and orthopedic surgeons had different spine surgical profiles and costs.