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 this 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. You may not think someone else’s problems after surgery affect you, but as a taxpayer, many of these costs come from folks on Medicare. From a societal perspective, these costs are paid for by me and you. And that makes it everyone’s business.
Before looking at the specific results of this study, consider some of the points the authors make. First, the number of people seeking treatment for spine problems is increasing every year. So is the age of the patients looking for help. Along with an increased number of older adults in need of spinal surgery, there has been a steady rise in health care costs. The complexity of many procedures has also increased, which also pushes costs higher.
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.
The question arises: should patients with multiple health problems be refused surgery? 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.
What can be done to change all this? The authors do not offer any immediate solutions. They suggest the move to electronic medical records will make it possible to track costs and risk factors more closely. Likewise, any interventions applied to the problem can be analyzed to find the most efficient and effective course of action for each problem. Being able to identify patients at risk and predict the likelihood of a complication may help target those patients for prevention. As this study shows, much of the burden for change lies with improving internal measures (e.g., surgeon technique, hospital care) to reduce complications.