712915 - The Economic Impact of Hospital Acquired Conditions in Open, Minimally Invasive, and Robot Assisted Lumbar Fusion Surgery

Thursday, February 27, 2020

1:30 PM – 1:35 PM

Location: 208

Participants should be aware of the following financial/non-financial relationships:

Jack Zhong, BA: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Peter G. Passias, MD: AlloSource (Individual(s) Involved: Self, Products/Services: Financial Support): Financial Support; Globus Medical (Individual(s) Involved: Self, Products/Services: Paid Presenter or Speaker): Paid Presenter or Speaker; Medicrea (Individual(s) Involved: Self, Products/Services: N/a): Paid consultant; SpineWave (Individual(s) Involved: Self, Products/Services: Paid Consultant): Paid consultant; The Cervical Spine Research Society (Individual(s) Involved: Self, Products/Services: Grant): Grant; Zimmer Biomet (Individual(s) Involved: Self, Products/Services: Paid Presenter or Speaker): Paid Presenter or Speaker

Avery Brown: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Katherine E. Pierce, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Cole Bortz, BA: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Haddy Alas, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Hamid Hassanzadeh, MD: Depuy Synthes (Individual(s) Involved: Self, Products/Services: Consutant): Consultant; Globus (Individual(s) Involved: Self, Products/Services: Teaching): Teaching; Medtronic Inc. (Individual(s) Involved: Self, Products/Services: Consultant): Consultant; NuVasive (Individual(s) Involved: Self, Products/Services: Consultant): Consultant; Orthofix (Individual(s) Involved: Self, Products/Services: Research Support): Research support and teaching; Pfizer (Individual(s) Involved: Self, Products/Services: Research): Research support

Aaron J. Buckland, MD: EOS imaging (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; Medtronic (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; NuVasive (Individual(s) Involved: Self, Products/Services: Consultancy): Consultancy; Stryker Spine (Individual(s) Involved: Self, Products/Services: Consutancy): Consultancy

Michael Gerling, MD: Allosource (Products/Services: Other financial or material support)Cervical Scoliosis Research Society (Products/Services: Research support)Globus Medical (Products/Services: Paid presenter or speaker)Medicrea (Products/Services: Paid consultant)SpineWave (Products/Services: Paid consultant)Zimmer (Products/Services: Paid presenter or speaker)

Sara Naessig, BS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Brendan H. Jackson-Fowl, ScM: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Waleed Ahmad, MS: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Irene Chern: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: Lumbar fusion surgery is a constantly evolving field, with recent advances including minimally invasive (MIS) and robot assisted spine surgery. However, it is unknown if there has been a commensurate rise in the rates of post-operative non-reimbursable events.

Purpose: Investigate the rates of economic impact of non-reimbursable events in lumbar spine fusion surgery.
Study Design/Setting: Retrospective review of a single center spine surgery database.
Patient Sample: 360 propensity matched patients.
Outcome Measures: Non-reimbursable events, costs.

Methods: Inclusion criteria: surgical patients >18 years undergoing lumbar fusion surgery. Patients were categorized into 3 groups based on procedure type: open, MIS, or robot. Open included those undergoing open poster spinal fusion. MIS included those undergoing transforaminal or lateral lumbar interbody fusion with percutaneous screws. Robot were those undergoing robot assisted interbody fusion. Propensity score matching was performed between all groups for the number of levels fused. The rates of post-operative complications and non-reimbursable events were assessed for each group. Non-reimbursable events were defined as: surgical site infections (SSIs), urinary tract infections (UTIs), pulmonary embolisms or deep venous thromboembolisms (PE/DVT). The costs of non-reimbursable events were calculated using the PearlDiver database. For robot cases, costs were reflective of operational fees and initial purchase costs. Complications and comorbidities (CC) and major complications and comorbidities (MCC) were assessed according to CMS.gov manual definitions.

Results: 360 propensity matched patients (120 open, 120 MIS, 120 robot) were included. Descriptive statistics for the cohort were: age 58.8 ± 13.5, 50% women, BMI 29.4 ± 6.3, op time 294.4 ± 119.0, LOS 4.56 ± 3.31 days, EBL 515.9 ± 670.0 cc, and 2.3 ± 2.2 average levels fused. Overall, rates of post op complications were significantly higher in robotic cases versus open and MIS (43% vs. 21% and 22% for open and MIS, p<0.05). When compared to open and MIS, robotic cases had higher rates of non-reimbursable events (12.0% robotic vs. 8.0% open, and 7.0% MIS, both p<0.001), as well as baseline surgery costs (($60,047.01 vs. $42,538.98 open and $41,471.21 MIS). On average, non-reimbursable events costs $20,299.07. The overall costs of care for patients who experienced non reimbursable events was significantly higher for robotic patients compared to open and MIS ($79,094.35 robot vs. $63,902.18 open and $61,957.87 MIS, both p<0.05).

Conclusions: Non-reimbursable events represent a significant burden to cost efficiency in healthcare. While lumbar surgery techniques have advanced, little is known of the effect on non-reimbursable events. When matched for levels fused, robot assissted surgery patients had 30% higher costs of surgery and significantly higher rates of never events compared to minimally invasive and open spine surgery patients. However, further longitudinal research is needed to fully assess the impact of non-reimbursable events lumbar spine surgery.

Presenting Author(s)

Jack Zhong, BA

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Peter G. Passias, MD

Associate Professor NYU School of Medicine
NYU Langone Orthopedic Hospital

Disclosure: AlloSource : Financial Support (Status: Ongoing); Globus Medical : Paid Presenter or Speaker (Status: Ongoing); Medicrea : Paid consultant (Status: Ongoing); SpineWave : Paid consultant (Status: Ongoing); The Cervical Spine Research Society : Grant (Status: Ongoing); Zimmer Biomet : Paid Presenter or Speaker (Status: Ongoing)
Avery Brown

Medical Student
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Katherine E. Pierce, BS

Research Fellow
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Cole Bortz, BA

Research Fellow
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Haddy Alas, BS

Medical Student
NYU Langone Orthopaedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Hamid Hassanzadeh, MD

Associate Professor
Dept Orthopaedic Surgery, University of Virginia

Disclosure: Depuy Synthes : Consultant (Status: Ongoing); Globus : Teaching (Status: Ongoing); Medtronic Inc. : Consultant (Status: Ongoing); NuVasive : Consultant (Status: Ongoing); Orthofix : Research support and teaching (Status: Ongoing); Pfizer : Research support (Status: Terminated --- 12/2019)
Aaron J. Buckland, MD

Associate Professor of Orthopedic Surgery, Director of Spine Research
NYU Langone Health

Disclosure: EOS imaging : Consultancy (Status: Ongoing); Medtronic : Consultancy (Status: Ongoing); NuVasive : Consultancy (Status: Ongoing); Stryker Spine : Consultancy (Status: Ongoing)
Michael Gerling, MD

Spine Surgeon
NYU Langone Orthopaedic Hospital

Disclosure: Allosource (Products/Services: Other financial or material support)Cervical Scoliosis Research Society (Products/Services: Research support)Globus Medical (Products/Services: Paid presenter or speaker)Medicrea (Products/Services: Paid consultant)SpineWave (Products/Services: Paid consultant)Zimmer (Products/Services: Paid presenter or speaker)
Sara Naessig, BS

Researcher
New York University Langone Medical Center

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Brendan H. Jackson-Fowl, ScM

Intern
NYU Langone Orthopedic Spine Surgery

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Waleed Ahmad, MS

N/A
NYU Langone Orthopedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Irene Chern

Research Assistant
NYU Langone Orthopaedic Hospital

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.