An economic evaluation of perioperative adverse events associated with spinal surgery

• Published in: The spine journal 2013, Vol.13 (1), p.44-53
• Main Authors: Hellsten, Erik K., BA, Hanbidge, Michelle A., BESc, Manos, Aspasia N., BSc, Lewis, Stephen J., MD, FRCSC, Massicotte, Eric M., MD, FRCSC, Fehlings, Michael G., MD, PhD, FRCSC, Coyte, Peter C., PhD, Rampersaud, Y. Raja, MD, FRCSC
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - economics; Academic Medical Centers - statistics & numerical data; Adult; Adverse events; Aged; Comorbidity; Cost Savings - economics; Cost Savings - statistics & numerical data; Female; Health Expenditures - statistics & numerical data; Health-Economic evaluation; Hospital Costs - statistics & numerical data; Humans; Intraoperative Complications - economics; Intraoperative Complications - epidemiology; Length of Stay - economics; Length of Stay - statistics & numerical data; Male; Middle Aged; Multivariate Analysis; Orthopedics; Outcome Assessment (Health Care) - economics; Postoperative Complications - economics; Postoperative Complications - epidemiology; Prospective Studies; Spinal Diseases - economics; Spinal Diseases - epidemiology; Spinal Diseases - surgery; Spinal Fusion - adverse effects; Spinal Fusion - economics; Spine surgery
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2013.01.003

Abstract Background context Besides their clinical impact, the economic impact of health care–related adverse events (AEs) is significant. Although a number of studies have attempted to estimate the economic impact of AEs, few have directly linked costs to clinician-reported event severity. Purpose To estimate the economic impact in terms of the incremental cost and length of stay (LOS), attributable to different severity grades of AEs that occurred during perioperative spinal surgery. Study design Health economic evaluation of data from a prospective observational study from the perspective of an academic hospital. Patient sample Consecutive patients at a single, tertiary-quaternary care institution who have undergone inpatient spinal surgery. Outcome measures The cost and LOS impacts with respect to the severity of the AEs. Methods We analyzed 4 years of patient discharges between January 1, 2007 and December 31, 2010. The Spine Adverse Events Severity instrument was completed by the surgical team at discharge. Clinical impacts of the AEs were graded as I (requires no/minimal treatment), II (requires treatment and is not likely to cause long-term [>6 months] sequelae), III (requires treatment and is most likely to cause long-term sequelae), and IV (death). A total of 1,815 records were linked with the patient-level costing information. We matched each AE case with four control cases based on their propensity score for the risk of experiencing an AE, regressed against case characteristics. We estimated an incremental cost and LOS for each severity grade by calculating the differences in means across cases and controls. We conducted a sensitivity analysis by estimating the alternate models using generalized linear model (GLM) regression with a gamma log link. Results Adverse events were reported in 316 (17.4%) cases, with 126 of these patients (40.2%) experiencing multiple events. The incremental cost/LOS for each severity grade are as follows: I =$4,224 (p=.0351)/3.63 days (p=.0001); II =$23,500 (p