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Resource Utilization in Adolescent Idiopathic Scoliosis Surgery: Is There Opportunity for Standardization?

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Abstract

Introduction

Recent healthcare reforms have raised the importance of cost and value in the management of disease. Value is a function of benefit and cost. Understanding variability in resources utilized by individual surgeons to achieve similar outcomes may provide an opportunity for cutting costs though greater standardization. The purpose of this study is to evaluate differences in use of implants and hospital resources among surgeons performing adolescent idiopathic scoliosis (AIS) surgery.

Methods

A multicenter prospective AIS operative database was queried. Patients were matched for Lenke curve type and curve magnitude, resulting in 5 surgeons and 35 matched groups (N = 175). Mean patient age was 14.9 years and curve magnitude 50°. Parameters of interest were compared between surgeons via ANOVA and Bonferroni pairwise comparison.

Results

There was no significant difference in percentage curve correction or levels fused between surgeons. Significant differences between surgeons were found for percentage posterior approach, operative time, length of stay (LOS), estimated blood loss (EBL), cell saver transfused, rod material, screw density, number of screws, use of antifibrinolytics, and cessation of intravenous analgesics. Despite differences in EBL and cell saver transfused, there were no differences in allogenic blood (blood bank) use.

Conclusion

Significant variability in resource utilization was noted between surgeons performing AIS operations, although radiographic results were uniform. Standardization of resource utilization and cost containment opportunities include implant usage, rod material, LOS, and transition to oral analgesics, as these factors are the largest contributors to cost in AIS surgery.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Mount Sinai-Beth Israel Medical Center, Scoliosis and Spine Associates, 820 Second Avenue, New York, NY 10017, USA

    Baron S. Lonner MD

  2. Scoliosis and Spine Associates, New York University School of Medicine, 820 Second Avenue, New York, NY 10017, USA

    Courtney S. Toombs BA

  3. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, Scoliosis and Spine Associates, 820 Second Avenue, New York, NY 10017, USA

    Justin C. Paul MD, PhD

  4. Department of Orthopaedic Surgery, AI Du Pont Hospital, Nemours Children’s Clinic - Wilmington of the Nemours Foundation, 1600 Rockland Road, Wilmington, DE, 19803, USA

    Suken A. Shah MD

  5. Department of Orthopaedic Surgery, Miami Children’s Hospital, Nicklaus Children’s Orthopedic Spine Center, 3100 SW 62 Avenue NE Wing #108, Miami, FL, 33155, USA

    Harry L. Shufflebarger MD

  6. Department of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Division of Orthopedic Surgery, 2nd Floor Wood Building, 34th St. & Civic Center Blvd., Philadelphia, PA, 19104, USA

    John M. Flynn MD

  7. Department of Orthopaedic Surgery, Rady Children’s Hospital, Pediatric Orthopedic & Scoliosis Ctr, 3030 Children’s Way #410, San Diego, CA, 92123, USA

    Peter O. Newton MD

Authors
  1. Baron S. Lonner MD
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  2. Courtney S. Toombs BA
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  3. Justin C. Paul MD, PhD
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  4. Suken A. Shah MD
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  5. Harry L. Shufflebarger MD
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  6. John M. Flynn MD
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  7. Peter O. Newton MD
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Corresponding author

Correspondence to Baron S. Lonner MD.

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Author disclosures

BSL (grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation; personal fees from DePuy Synthes Spine, K2M, Paradigm Spine, Spine Search, and Ethicon; nonfinancial support from Spine Deformity Journal; grants from AO Spine, John and Marcella Fox Fund Grant, and OREF, outside the submitted work); CST (none); JCP (none); SAS (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants from Setting Scoliosis Straight Foundation; personal fees from DePuy Synthes Spine, outside the submitted work); HLS (none); JMF (reports other from Biomet, other from LWW, outside the submitted work); PON (reports grants from Setting Scoliosis Straight Foundation, during the conduct of the study; grants and other from Setting Scoliosis Straight Foundation, other from Rady Children’s Specialists, grants and personal fees from DePuy Synthes Spine, personal fees from Law firm of Carroll, Kelly, Trotter, Franzen & McKenna, and the Law firm of Smith, Haughey, Rice & Roegge; grants from NIH and OREF, grants and other from SRS; grants from EOS imaging; personal fees from Thieme Publishing; other from NuVasive; personal fees from Ethicon Endosurgery; other from Electrocore; personal fees from Cubist; other from International Orthopedic Think Tank; other from Orthopediatrics Institutional Support, and personal fees from K2M, outside the submitted work; in addition, PON has a patent “Anchoring systems and methods for correcting spinal deformities” (8540754) with royalties paid to DePuy Synthes Spine, a patent “Low profile spinal tethering systems” (8123749) issued to DePuy Spine, Inc.; a patent “Screw placement guide” (7981117) issued to DePuy Spine, Inc.; and a patent “Compressor for use in minimally invasive surgery” (7189244) issued to DePuy Spine, Inc.).

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Lonner, B.S., Toombs, C.S., Paul, J.C. et al. Resource Utilization in Adolescent Idiopathic Scoliosis Surgery: Is There Opportunity for Standardization?. Spine Deform 5, 166–171 (2017). https://doi.org/10.1016/j.jspd.2017.01.002

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  • DOI: https://doi.org/10.1016/j.jspd.2017.01.002

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