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Geographic Variations in the Cost of Spine Surgery

Goz, Vadim, MD; Rane, Ajinkya, MD; Abtahi, Amir M., MD; Lawrence, Brandon D., MD; Brodke, Darrel S., MD; Spiker, William Ryan, MD

doi: 10.1097/BRS.0000000000001022

Study Design. Retrospective review.

Objective. To define the geographic variation in costs of anterior cervical discectomy and fusion (ACDF) and posterolateral fusion (PLF).

Summary of Background Data. ACDF and lumbar PLF are common procedures that are used in the treatment of spinal pathologies. To optimize value, both the benefits and costs of an intervention must be quantified. Data on costs are scarce in comparison with data on total charges. This study aims at defining the costs of ACDF and PLF and describing the geographic variation within the United States.

Methods. Medicare Provider Utilization and Payment data were used to investigate the costs associated with ACDF, PLF, and total knee arthroplasty (TKA). Average total costs of the procedures were compared by state and geographic region.

Results. Combined professional and facility costs for a single-level ACDF had a national mean of $13,899. Total costs for a single-level PLF had a mean of $25,858. Total costs for a primary TKA had a national mean of $13,039. The cost increased to an average of $22,138 for TKA with major comorbidities. Analysis of geographic trends showed statistically significant differences in total costs of PLF, TKA, and TKA, with major complications or comorbidities between geographic regions (P < 0.01 for all).

Conclusion. Three of the 4 procedures (PLF, TKA, and TKA with major complications or comorbidities) showed statistically significant variation in cost between geographic regions. The Midwest provided the lowest cost for all procedures. Similar geographic trends in the cost of spinal fusions and TKAs suggest that these trends may not be limited to spine-related procedures. Surgical costs were found to correlate with cost of living but were not associated with the population of the state. These data shed light on the actual cost of common surgical procedures throughout the United States and will allow further progress toward the development of cost-effective, value-driven care.

Level of Evidence: 3

This study defines the costs anterior cervical discectomy and fusion and posterolateral fusion and investigates the geographic variation in these costs. The Midwest provides the lowest cost for all procedures investigated. Similar geographic trends were found in the cost of total knee arthroplasties, suggesting that these trends may not be limited to spine-related procedures.

From the Department of Orthopaedics, The University of Utah, Salt Lake City, UT.

Address correspondence and reprint requests to William Ryan Spiker, MD, Department of Orthopaedics, The University of Utah, 590 Wakara Way, Salt Lake City, UT 84108; E-mail:

Acknowledgment date: April 17, 2015. Acceptance date: June 3, 2015.

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: consultancy, royalties, stocks, grants, payment for lectures, travel/accommodations/meeting expenses, other (fellowship support).

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.