Hospital charges for spinal fusion surgery in the upper spine vary considerably — with the surgeon’s choice of spinal hardware being the largest source of variation, according to a resent study in Spine

The study shows that costs vary by surgeon, with higher hospital charges for patients treated by certain surgeons. "Both surgeon’s choices and the choice of surgeons influenced the total hospital charges for performing spinal fusion," according to research led by Nancy E. Epstein, MD, of The Albert Einstein College of Medicine, Bronx, NY.

Epstein and colleagues analyzed charges for 102 spinal fusion surgeries performed at a single hospital over a one-year period. They focused on a procedure called single-level anterior cervical discectomy/fusion — surgery to fuse two adjacent vertebrae in the neck.

Total hospital charges varied substantially:  from about $27,000 to $129,000.  To clarify the reasons for the variations, the researchers broke down costs into different categories and attempted to identify the factors responsible for higher costs in each category.

Like total charges, inpatient hospital charges showed a fivefold variationfrom about $15,000 to $77,000. In this category, the greatest source of variation was the number of days spent in the hospital, which ranged from one to eleven. For surgical charges, the range was even greater from about $4,000 to $40,000.  This tenfold variation was largely related to the surgeon’s choice of instrumentation (hardware) for spinal fusion. 

"When combined with surgeon’s choices for associated supplies…the number of combinations of instrumentation and supplies becomes enormous, along with a large range of associated costs," said Epstein.

Six surgeons performed about three-fourths of the operations. The researchers found that costs were significantly higher for patients operated on by one particular surgeon:  average total charges $82,000, compared to $65,000 for the other five surgeons combined. 

In addition to documenting five- to ten-fold variations in costs, the study suggests reasons why costs are higher for some patients than others — including the type of instrumentation chosen by the surgeon as well as the surgeon performing the operation. Epstein and colleagues conclude, "As society focuses on the rising cost of medical care, spine surgeons can take proactive steps to reduce the total hospital charges associated with [spinal fusion], one of the most commonly performed cervical operations." 

Spine is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health

[Source: Wolters Kluwer]