Dad had surgery two months ago for a spinal fusion that turned out to be a big mess. Now the hospital where he stayed is trying to say that the fact that he has high blood pressure and is overweight is the reason he had problems. It looks to us like it was more a matter of poor care while in the hospital. I can name off a list for you. The question is: in cases like this — what’s the patient’s responsibility and when should the hospital pony up and help pay some of the added costs of problems that develop after surgery?

This is an excellent question and one that some researchers are actively studying. Many people in need of spinal surgery also suffer from other health problems such as high blood pressure, diabetes, cancer, obesity, neurologic problems and many others. These additional conditions are referred to as comorbidities. Patients often have more than one comorbidity. And then there are the complications that can occur after surgery. Comorbidities and complications take their toll on patients but can also add quite a bit to the hospital bill and cost of health care overall.

In a recent study from the University of Pennsylvania, the effect of comorbidities and complications (both minor and major) are examined. The researchers determined which problems are the most significant but also looked at the costs.

Efforts are being made to contain costs. Hospitals, private payers, and government are starting to take a closer look at what’s going on and how to cut costs. This study is an example of those efforts. The focus here is on patient characteristics that affect the cost of spinal care. Along with known risk factors such as obesity and smoking, other areas of health concerns were included.

Data on 226 patients undergoing spinal surgery for a variety of reasons was collected. Age, sex (male or female), body mass index (BMI, an indicator of obesity), number and type of comorbidities, type of procedure, and type and number of complications were reported and analyzed.

They found that although high blood pressure (hypertension) was the most common comorbidity, the problems that caused the most difficulty were pulmonary (blood clots, pneumonia), improper positioning of hardware used in spinal fusions, new neurologic problem (caused by the surgery), and wound infection.

Costs started escalating when a problem developed as a result of being in the hospital. This is referred to as a hospital-acquired condition or HAC. Those additional costs spiraled upwards as complications increased in number or severity. Longer hospital stays require more care and greater use of resources. The result is an increase in the cost to insurance companies (or payers like Medicare). Likewise, when the costs are greater than the reimbursement, then hospitals take a financial hit, too.

Questions such as you raised come up: should patients with multiple health problems be refused surgery? Who is responsible to pay when problems develop outside the patient’s control and possibly the result of the care they received (or didn’t receive)?

This study actually shows that the majority of problems were caused by the hospitalization and/or the surgery itself. And many of the problems required an additional surgery further raising costs associated with hospital acquired conditions.