Costs and utility of post-discharge acute inpatient rehabilitation following adult spinal deformity surgery

Abstract

Purpose

Evaluate costs and functional utility of post-discharge rehabilitation after surgery for adult spinal deformity (ASD).

Methods

Retrospective analysis of ASD patients who underwent operation at a single center and discharged to one rehabilitation facility. Operative details and costs were obtained for index inpatient encounter. Rehabilitation data included: direct costs, length of stay, and patient function, as assessed by Functional Independence Measure (FIM) instrument.

Results

Of 937 operations, 391 (41.7%) were discharged to rehabilitation. Ninety-patients (9.6%; 95 care episodes; average age 70.5 ± 10.6 years) were discharged to rehabilitation. Inpatient length of stay was 8.2 ± 2.6 days. Operative details: posterior levels fused 13.6 ± 3.6, PCOs/patient 7 ± 3.7, forty-two 3-column osteotomies, and 11 inter-body fusions. Direct costs were $90,738 ± $24,166 for index hospitalizations and $38,808 ± $14,752 for rehabilitation. Patients spent 11.7 ± 4.0 days in rehabilitation. Direct cost per day in hospital ($11,758 ± $3390) was significantly greater than rehabilitation ($3338 ± $2131) (p < 0.05). Significant improvements in function while in rehabilitation were observed (admit FIM: 66 ± 14 vs. discharge FIM: 94 ± 14). Charlson Comorbidity Index was the only independent predictor of rehabilitation direct costs.

Conclusion

Post-discharge inpatient rehabilitation following operations for ASD is associated with a direct cost of $38,808 per case. While rehabilitation resulted in significant functional improvements, it came at significant economic expense ($3.7 million) that accounted for 30% of costs for 95 episodes of care. For 100 operatively treated patients (assuming 41% discharge rate to rehab), rehabilitation results in an additional price premium of $1,674,872.

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Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work: AAT, DL, CDO, AT, VT, CPA; Drafted the work or revised it critically for important intellectual content: AAT, DL, CDO, AT, VT, CPA; Approved the version to be published: AAT, DL, CDO, AT, VT, CPA; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: AAT, VT, CPA.

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Correspondence to Alekos A. Theologis.

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Theologis, A.A., Lau, D., Dalle-Ore, C. et al. Costs and utility of post-discharge acute inpatient rehabilitation following adult spinal deformity surgery. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00251-w

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Keywords

  • Adult spinal deformity
  • Acute rehabilitation
  • Discharge
  • Cost