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Inpatient Vertebral Augmentation: A Cost Benefit Analysis 2011

Interventional Spine

Jonathan, A, Flug, MD, MBA
Ann, Hanford, RN, Non ASSR Member
A Orlando, Ortiz, MD, MBA, Non ASSR Member

Paper/Mentor

Purpose

The purpose of this study was to assess the cost-effectiveness of vertebral augmentation versus conservative medical management on the inpatient population at a single academic institution.

Methods & Materials

Institutional review board approval was obtained for this study. Patients were retrospectively identified using diagnostic related group and billing data between April of 2008 and September of 2010 who were admitted to our institution with a diagnosis of vertebral compression fracture (ICD-9 codes 733.13, 805.2, & 805.4). Of these patients, those who had vertebral augmentation performed in our Radiology department during their hospitalization were identified using billing data (ICD-9 codes 81.65 & 81.66) and were compared to those patients who did not have any operative interventions for their vertebral compression fracture(s) during their admission. Patients who had vertebral augmentation by non-radiologists and patients who had open surgical repairs were excluded from the evaluation. The total length of stay, total cost of the hospitalization, cost per day of hospitalization, and thirty-day readmission rates were compared between the two groups. Two-tailed t-tests were used to compare the two groups for statistical significance.

Results

39 inpatients were identified who underwent vertebral augmentation during their hospitalizations with a total of 61 vertebral levels augmented, and an average age of 81.7 years. 70% were female. During the same period, 209 patients were treated medically for vertebral compression fracture with an average age of 72.7 years. 68% were female. The average total length of stay was 13.8 days, compared to an average of 8.1 days in the control group. This difference was statistically significant. However, on average, patients underwent augmentation on day 8.6 of their hospitalization. Approximately half of these patients were discharged within 4 days of the procedure, with the average discharge of 5.2 days post procedure. The total cost of admission and average daily cost were $25,343 & $2,082 in the augmentation group compared to $15,507 & $2069 in the control group. There was no significant difference in the average cost per day between the two groups. The 30-day readmission rate in the augmentation group was 15.4% with none being related to vertebral compression fracture. This rate was 12.4% in the control group, with almost half of those cases related to vertebral compression fracture.

Conclusion

Vertebral augmentation can be performed on the inpatient population in a cost effective manner as demonstrated by the lack of difference between the cost per day between the two groups. Total cost was significantly higher in the augmentation group, however this is likely related to the increased lengths of stay in this group. By performing vertebral augmentation on the appropriate subset of inpatients earlier in their hospital stays, total costs can be decreased. The amount of time from admission to augmentation, in our study averaged 8.6 days, at a cost of $18,060 per patient admission. Increasing awareness among referring clinicians can help expedite the identification of these patients and facilitate their treatment and discharge.

References/Financial Disclosures

1. Bogduk N, Polly JR DW. Value in Spine Treatment. Spineline. Sept-Oct 2010, Pgs 22-27. 2. Trout AT, Gray LA, Kallmes DF. Vertebroplasty in the Inpatient Population. AJNR; 26:1629 â