in Journal of Neurosurgery
F
in Journal of Neurosurgery: Spine
OBJECTIVE
Multiple studies have demonstrated the safety of outpatient spine surgery, with reports of equivalent to improved patient outcomes compared with inpatient procedures. This has resulted in the increased use of outpatient surgery over time. However, there remains a paucity of literature evaluating the difference in costs between ambulatory surgery center (ASC)– and hospital outpatient department (HOPD)–based procedures for Medicare beneficiaries.
METHODS
Publicly available data from Centers for Medicare & Medicaid Services were accessed via the Medicare Procedure Price Lookup tool. Current Procedural Terminology (CPT) codes were used to identify spine-specific procedures approved for the outpatient setting by CMS. Procedures were grouped into decompression (cervical, thoracic, and lumbar), fusion/instrumentation (cervical, lumbar, and sacroiliac), and kyphoplasty/vertebroplasty cohorts, as well as an overall cohort. Data regarding total costs, facility fees, surgeon reimbursement, Medicare payments, and patient copayments were extracted for each procedure. Descriptive statistics were used to calculate means and standard deviations. Differences between ASC- and HOPD-associated costs were analyzed using the Mann-Whitney U-test.
RESULTS
Twenty-one individual CPT codes approved by Medicare for the ASC and/or HOPD setting were identified. Decompression procedures were associated with a significantly lower total cost ($4183 ± $411.07 vs $7583.67 ± $410.89, p < 0.001), facility fees ($2998 ± $0 vs $6397 ± $0, p < 0.001), Medicare payments ($3345.75 ± $328.80 vs $6064.75 ± $328.80, p < 0.001), and patient payments ($835.58 ± $82.13 vs $1515.58 ± $82.13, p < 0.001) in ASCs compared with HOPDs. Fusion/instrumentation procedures had significantly lower facility fees ($10,436.6 ± $2347.51 vs $14,161 ± $2147.07, p = 0.044) and Medicare payments ($9501.2 ± $1732.42 vs $13,757 ± $2037.58, p = 0.009) in ASCs, as well as a trend toward lower total costs ($11,876.8 ± $2165.22 vs $15,601.2 ± $2016.06, p = 0.076). Patient payments in the HOPD setting were significantly lower in the fusion/instrumentation cohort ($1843.6 ± $73.42 vs $2374.4 ± $433.48, p = 0.009). In the kyphoplasty/vertebroplasty cohort, there was no statistically significant difference between ASCs and HOPDs, despite lower overall costs in the ASC for all variables. Surgeon fees were the same regardless of setting for all procedures (p > 0.99). When combining decompression, fusion/instrumentation, and kyphoplasty/vertebroplasty CPT codes into a single cohort, ASC setting was associated with significant cost savings in total cost, facility fees, Medicare payments, and patient payments.
CONCLUSIONS
In general, performing spine surgeries in ASCs is associated with cost savings compared with HOPDs. This was demonstrated for decompression and fusion/instrumentation, and kyphoplasty/vertebroplasty Medicare-approved outpatient procedures.
in Journal of Neurosurgery: Pediatrics
In Brief
The authors conducted a retrospective analysis of 70 patients undergoing evaluation during shunt failure to find predictors of ETV success. They found that age < 36 months, primary inflammatory hydrocephalus, and obstruction at fourth ventricle outlets were associated with ETV failure. A meta-analysis is also provided, confirming the results. Finally, the authors focus on patients experiencing signs and symptoms of global rostral midbrain dysfunction syndrome during shunt dysfunction, in which ETV is effective in improving clinical outcome.
in Journal of Neurosurgery
In Brief
The objective of this study was to determine hemorrhage risk after Gamma Knife radiosurgery (GKRS) for melanoma brain metastases. A patient's risk of definite hemorrhage was 17% at 36 months, and 5% required surgery. This rate is similar to or lower than the previously reported risk of hemorrhage prior to GKRS. The risk dropped over time and 95% of hemorrhages occurred within the 1st year. These data may assist in counseling patients prior to treatment.
in Journal of Neurosurgery: Spine
In Brief
The objective of our study was to assess the academic career progression of prior recipients of the JANE, Mayfield, and Kuntz research awards. Many recipients of the Spine Section awards have successfully translated award-winning abstracts into peer-reviewed publications, with approximately one-third of the awardees active in academic neurosurgery. Early participation in spine research may increase future involvement in academic spine endeavors.
in Journal of Neurosurgery: Pediatrics
In Brief
This study aimed to identify patient demographic and injury factors associated with major and immobility-related adverse events among children with spinal cord injury. The authors demonstrated that cervical complete injuries, concomitant severe abdominal trauma, and Glasgow Coma Scale scores < 13 at presentation were associated with the occurrence of adverse events. These findings have important implications for pediatric spinal cord injury providers and should be used to inform care pathways for patients sustaining these injuries.
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JNSPG Journal Club
September 2023 - Cervical spondylotic myelopathy
Featuring presentations on selected articles published in this issue by Dr. Jay Turner, Dr. Michael D. White, Dr. David Levi, Dr. Michael Y. Wang, and Dr. Ken Porche. Moderated by Dr. Praveen V. Mummaneni with Drs. William Couldwell (Editor-in-Chief) and Aaron Cohen-Gadol (Associate Editor).
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