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Cost Analysis of Incidental Durotomy in Spine Surgery

Nandyala, Sreeharsha V. BA; Elboghdady, Islam M.; Marquez-Lara, Alejandro MD; Noureldin, Mohamed N. B. MD; Sankaranarayanan, Sriram MD; Singh, Kern MD

Spine:
doi: 10.1097/BRS.0000000000000425
Epidemiology
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Abstract

Study Design. Retrospective database analysis.

Objective. To characterize the consequences of an incidental durotomy with regard to perioperative complications and total hospital costs.

Summary of Background Data. There is a paucity of data regarding how an incidental durotomy and its associated complications may relate to total hospital costs.

Methods. The Nationwide Inpatient Sample database was queried from 2008 to 2011. Patients who underwent cervical or lumbar decompression and/or fusion procedures were identified, stratified by approach, and separated into cohorts based on a documented intraoperative incidental durotomy. Patient demographics, comorbidities (Charlson Comorbidity Index), length of hospital stay, perioperative outcomes, and costs were assessed. Analysis of covariance and multivariate linear regression were used to assess the adjusted mean costs of hospitalization as a function of durotomy.

Results. The incidental durotomy rate in cervical and lumbar spine surgery is 0.4% and 2.9%, respectively. Patients with an incidental durotomy incurred a longer hospitalization and a greater incidence of perioperative complications including hematoma and neurological injury (P < 0.001). Regression analysis demonstrated that a cervical durotomy and its postoperative sequelae contributed an additional adjusted $7638 (95% confidence interval, 6489–8787; P < 0.001) to the total hospital costs. Similarly, lumbar durotomy contributed an additional adjusted $2412 (95% confidence interval, 1920–2902; P < 0.001) to the total hospital costs. The approach-specific procedural groups demonstrated similar discrepancies in the mean total hospital costs as a function of durotomy.

Conclusion. This analysis of the Nationwide Inpatient Sample database demonstrates that incidental durotomies increase hospital resource utilization and costs. In addition, it seems that a cervical durotomy and its associated complications carry a greater financial burden than a lumbar durotomy. Further studies are warranted to investigate the long-term financial implications of incidental durotomies in spine surgery and to reduce the costs associated with this complication.

Level of Evidence: 3

In Brief

An incidental durotomy and its associated clinical sequelae contributed an additional $7638 in adjusted total hospital costs for cervical spine surgery and $2412 for lumbar procedures. In addition, incidental durotomies are associated with a longer hospitalization and a greater incidence of perioperative complications including hematoma and neurological injury.

Author Information

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Ste #300, Chicago, IL 60612; E-mail: Kern.singh@rushortho.com

Acknowledgment date: December 10, 2013. First revision date: January 29, 2014. Second revision date: March 18, 2014. Accepted date: April 29, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties.

© 2014 by Lippincott Williams & Wilkins