Patient Comorbidities and Complications After Spinal Surgery

STUDY DESIGN: Prospective observational study. OBJECTIVE: To determine how patient comorbidities and perioperative complications after spinal surgery affect the health care costs to society. SUMMARY OF BACKGROUND DATA: Despite efforts to reduce adverse events related to spinal surgery, complications are common and significantly increased by patient comorbidities. METHODS: Patients who underwent spinal surgery at a tertiary academic center during a 6-month period (May 2008 to December 2008) were prospectively followed. All demographic data, comorbidities, procedural information, and complications to 30-day follow-up were recorded. Diagnosis-Related Group codes and Current Procedural Terminology codes were captured for each patient. Direct costs were estimated from a societal perspective, using 2008 Medicare rates of reimbursement. A multivariable analysis was performed to assess the impact of specific patient comorbidities and complications on total health care costs. RESULTS: A total of 226 cases were analyzed. The mean cost of care for cases with complications was greater than that for cases without complications (13, 518. 35 95% confidence interval (CI), 9378. 80-17, 657. 90; P < 0. 0001). These results were consistent across degenerative, traumatic, and tumor/infection preoperative diagnoses. Cases with major complications were more costly than those with minor complications (13, 714. 88 CI, 6353. 02-21, 076. 74; P = 0. 0001). Systemic malignancy and preoperative neurological comorbidity were each associated with an increase in the cost of care (7919 CI, 2073-15, 225; P = 0. 006] and 5508 CI, 814-11, 198; P = 0. 02), respectively, when compared with a baseline cost of care derived from all cases in the database. The cost of care was increased by pulmonary complications (7233 CI, 3982. 53-11, 152. 88; P < 0. 0001), instrumentation malposition (6968 CI, 1705. 90-14, 277. 16; P = 0. 0062), new neurological deficit (4537 CI, 863. 95-9274. 30; P = 0. 013), and by wound infection (4067 CI, 1682. 79-6872. 39; P = 0. 0004), after adjustment for covariates. CONCLUSION: Both minor and major complications were found to increase the cost of care in a prospective assessment of spine surgery complications. Specific patient comorbidities and perioperative complications are associated with significant increases in the total cost of care to society.