Health Care Utilization and Payments of Postoperative and Drug Abuse-Related Spinal Infections.
Adult
Aged
Cohort Studies
Delivery of Health Care
/ economics
Female
Hospitalization
/ economics
Humans
Insurance, Health, Reimbursement
/ economics
Male
Middle Aged
Patient Acceptance of Health Care
Postoperative Care
/ economics
Postoperative Complications
/ economics
Retrospective Studies
Spinal Diseases
/ economics
Substance-Related Disorders
/ economics
Time Factors
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Oct 2019
15 Oct 2019
Historique:
pubmed:
31
5
2019
medline:
25
12
2019
entrez:
31
5
2019
Statut:
ppublish
Résumé
Retrospective analysis of data extracted from the MarketScan database (2000-2016) using International Classification of Diseases (ICD)-9, ICD-10, and Current Procedural Terminology-4 codes. Evaluate the economic costs and health care utilization associated with spine infections. Spinal infections (SI) are associated with significant morbidity and mortality. A recent spike in SI is attributed to the drug abuse epidemic. Management of SI represents a large burden on the health care system. We assessed payments and outcomes at the index hospitalization, 1-, 3-, 6-, and 12-month follow up. Outcomes assessed included length of stay, complications, operation rates, and health care utilization. Outcomes were compared between cohorts with spinal infections: (1) with prior surgery, (2) drug abuse, and (3) without previous exposure to surgery or drug abuse, denoted as control. We identified 43,972 patients; 15.6% (N = 6847) of patients underwent prior surgery, 3.8% (N = 1,668) were previously expose to drug abuse while 80.6% fell into the control group. Both the postsurgical and drug abuse groups longer hospital stay compared with the control cohort (5 d vs. 4 d, P < 0.0001). Exposure to IV drug abuse was associated with increased risk of complications compared with the control group (43% vs. 38%, P < 0.0001). Payments at 1-month follow-up were significantly (P < 0.0001) higher among the postsurgical group compared with both groups. However, at 12-months follow-up, payments were significantly (P < 0.0001) higher in the drug abuse group compared with both groups. Only postsurgical infections were associated with higher number of surgical interventions both at presentation and 1 year follow up. SI following surgery or IV drug abuse are associated with higher payments, complication rates, and longer hospital stays. Drug abuse related SI are associated with the highest complication rates, readmissions, and overall payments at 1 year of follow up despite the lower rate of surgical interventions. 3.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective analysis of data extracted from the MarketScan database (2000-2016) using International Classification of Diseases (ICD)-9, ICD-10, and Current Procedural Terminology-4 codes.
OBJECTIVE
OBJECTIVE
Evaluate the economic costs and health care utilization associated with spine infections.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Spinal infections (SI) are associated with significant morbidity and mortality. A recent spike in SI is attributed to the drug abuse epidemic. Management of SI represents a large burden on the health care system.
METHODS
METHODS
We assessed payments and outcomes at the index hospitalization, 1-, 3-, 6-, and 12-month follow up. Outcomes assessed included length of stay, complications, operation rates, and health care utilization. Outcomes were compared between cohorts with spinal infections: (1) with prior surgery, (2) drug abuse, and (3) without previous exposure to surgery or drug abuse, denoted as control.
RESULTS
RESULTS
We identified 43,972 patients; 15.6% (N = 6847) of patients underwent prior surgery, 3.8% (N = 1,668) were previously expose to drug abuse while 80.6% fell into the control group. Both the postsurgical and drug abuse groups longer hospital stay compared with the control cohort (5 d vs. 4 d, P < 0.0001). Exposure to IV drug abuse was associated with increased risk of complications compared with the control group (43% vs. 38%, P < 0.0001). Payments at 1-month follow-up were significantly (P < 0.0001) higher among the postsurgical group compared with both groups. However, at 12-months follow-up, payments were significantly (P < 0.0001) higher in the drug abuse group compared with both groups. Only postsurgical infections were associated with higher number of surgical interventions both at presentation and 1 year follow up.
CONCLUSION
CONCLUSIONS
SI following surgery or IV drug abuse are associated with higher payments, complication rates, and longer hospital stays. Drug abuse related SI are associated with the highest complication rates, readmissions, and overall payments at 1 year of follow up despite the lower rate of surgical interventions.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 31145379
doi: 10.1097/BRS.0000000000003102
pii: 00007632-201910150-00013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1449-1455Commentaires et corrections
Type : CommentIn
Références
Darouiche RO. Spinal epidural abscess. N Engl J Med 2006; 355:2012–2020.
Zimmerli W. Vertebral osteomyelitis. N Engl J Med 2010; 362:1022–1029.
Epstein N. Timing and prognosis of surgery for spinal epidural abscess: a review. Surg Neurol Int 2015; 6:S475–S486.
Schoenfeld AJ, Wahlquist TC. Mortality, complication risk, and total charges after the treatment of epidural abscess. Spine J 2015; 15:249–255.
Tay B, Deckey J, Hu SS. Spinal infections. J Am Acad Orthop Surg 2002; 10:188–197.
Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999; 52:189–196.
Hlavin M, Kaminski HJ, Ross JS, et al. Spinal epidural abscess: a ten-year perspective. Neurosurgery 1990; 27:177–184.
Espersen F, Frimodt-Møller N, Rosdahl TV, et al. Changing pattern of bone and joint infections due to Staphylococcus aureus: study of cases of bacteremia in Denmark, 1959-1988. Rev Infect Dis 1991; 13:347–358.
Corrah TW, Enoch DA, Aliyu SH, et al. Bacteraemia and subsequent vertebral osteomyelitis: a retrospective review of 125 patients. QJM 2011; 104:201–207.
Rummans TA, Burton CM, Dawson NL. How good intentions contributed to bad outcomes: the opioid crisis. Mayo Clin Proc 2018; 93:344–350.
Blecher R, Yilmaz E, Drazin D, et al. Recent increase in the rate of spinal infections may be related to growing substance-use disorder in the State of Washington: wide population-based analysis of the Comprehensive Hospital Abstract Reporting System (CHARS) database. Spine (Phila Pa 1976) 2019; 44:291–297.
Florence CS, Zhou C, Luo F, et al. The economic burden of prescription opioid overdose, abuse, and dependence in the United States, 2013. Med Care 2016; 54:901–906.
Patel H, Khoury H, Girgenti D, et al. Burden of surgical site infections associated with select spine operations and involvement of Staphylococcus aureus. Surg Infect (Larchmt) 2017; 18:461–473.
McGirt MJ, Parker SL, Lerner J, et al. Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients. J Neurosurg Spine 2011; 14:771–778.
Kuhns BD, Lubelski D, Alvin MD, et al. Cost and quality of life outcome analysis of postoperative infections after subaxial dorsal cervical fusions. J Neurosurg Spine 2015; 22:381–386.
Hansen L. The Truven Health MarketScan Databases for Life Sciences Researchers: White Paper; 2017: 22.
Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care 1998; 36:8–27.
Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 2005; 43:1130–1139.
Yeramaneni S, Robinson C, Hostin R. Impact of spine surgery complications on costs associated with management of adult spinal deformity. Curr Rev Musculoskelet Med 2016; 9:327–332.
Ronan MV, Herzig SJ. Hospitalizations related to opioid abuse/dependence and associated serious infections increased sharply, 2002-12. Health Aff (Millwood) 2016; 35:832–837.
Basu S, Ghosh J, Malik FH, et al. Postoperative discitis following single-level lumbar discectomy: our experience of 17 cases. Indian J Orthop 2012; 46:427–433.