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Determinants and Variations of Hospital Costs in Patients With Lumbar Radiculopathy Hospitalized for Spinal Surgery

Huysmans, Eva, MSc, PT∗,†,‡,§,¶; Pien, Karen, MSc, MD||; Callens, Lieselot, MSc, PT∗∗; Van Loon, Lesley, MSc, PT††; Ickmans, Kelly, PhD, PT†,§,¶; Nijs, Jo, PhD, PT, MT†,§,¶; Buyl, Ronald, PhD, PT‡,‡‡; Moens, Maarten, PhD, MD§§,¶¶,||||; Goudman, Lisa, MSc, PT, MT†,§,§§; Van Belleghem, Griet, MSc∗,‡; Putman, Koen, PhD, PT∗,‡

doi: 10.1097/BRS.0000000000002801
HEALTH SERVICES RESEARCH
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Study Design. A retrospective study.

Objective. The aim of this study was to determine hospital costs related to surgery for lumbar radiculopathy and identify determinants of intramural costs based on minimal hospital and claims data.

Summary of Background Data. Costs related to the initial hospitalization of patients undergoing surgery for lumbar radiculopathy make up the major part of direct health care expenditure in this population. Identifying factors influencing intramural costs can be beneficial for health care policy makers, and clinicians working with patients with lumbar radiculopathy.

Methods. The following data were collected from the University Hospital Brussels data warehouse for all patients undergoing surgery for lumbar radiculopathy in 2016 (n = 141): age, sex, primary diagnosis, secondary diagnoses, type of surgery, severity of illness (SOI), admission and discharge date, type of hospital admission, and all claims incurred for the particular hospital stay. Descriptive statistics for total hospital costs were performed. Univariate analyses were executed to explore associations between hospital costs and all other variables. Those showing a significant association (P < 0.05) were included in the multivariate general linear model analysis.

Results. Mean total hospital costs were € 5016 ± 188 per patient. Costs related to the actual residence (i.e., “hotel costs”) comprised 53% of the total hospital costs, whereas 18% of the costs were claimed for the surgical procedure. Patients with moderate/major SOI had 44% higher hospital costs than minor SOI (P = 0.01). Presence of preadmission comorbidities incurred 46% higher costs (P = 0.03). Emergency procedures led to 72% higher costs than elective surgery (P < 0.001). Patients receiving spinal fusion had 211% higher hospital costs than patients not receiving this intervention (P < 0.001).

Conclusion. Hospital costs in patients receiving surgery for lumbar radiculopathy are influenced by SOI, the presence of preadmission comorbidities, type of hospital admission (emergency vs. elective), and type of surgical procedure.

Level of Evidence: 3

The objective of this study was to determine hospital costs related to surgery for lumbar radiculopathy and to identify determinants of intramural costs. Mean total hospital costs were € 5000. Hospital costs were influenced by severity of illness, preadmission comorbidities, type of hospital admission, and type of surgical procedure.

I-CHER, Interuniversity Center for Health Economics Research Group, Belgium

Pain in Motion, International Research Group

Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium

§Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy (KIMA), Vrije Universiteit Brussel, Brussels, Belgium

Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Brussels, Belgium

||Medical Registration, Universitair Ziekenhuis Brussel, Brussels, Belgium

∗∗Private physiotherapy practice, Hellebuyck, Tielt, Belgium

††At the time of the study Lesley Van Loon was a student of the Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium

‡‡Department of Biostatistics and Medical Informatics, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium

§§Department of Neurosurgery and Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium

¶¶Center for Neurosciences, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium

||||Department of Manual Therapy (MANU), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.

Address correspondence and reprint requests to Eva Huysmans, MSc, PT, Vrije Universiteit Brussel, Building K-GEWE, Laarbeeklaan 103, BE-1090 Brussels, Belgium; E-mail: eva.huysmans@vub.be

Received 24 May, 2018

Revised 2 July, 2018

Accepted 3 July, 2018

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

The Agency for Innovation by Science and Technology (IWT) – Applied Biomedical Research Program (TBM), Belgium, funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, payment for lecture.

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