Perioperative Spending on Single Level Posterior Lumbar Fusion

From the 2019 HVPAA National Conference

Dr. Majd Marrache (Johns Hopkins Medical Institute), Mr. Andrew Harris (Johns Hopkins Medical Institute), Dr. Varun Puvanesarajah (Johns Hopkins Medical Institute), Dr. Michael Raad (Johns Hopkins Medical Institute), Dr. Amit Jain (Johns Hopkins Medical Institute)


Little is known regarding the contribution of preoperative and postoperative care to total spending in single level posterior lumbar fusion (PSF).


As bundled payments gain popularity, elucidating the drivers of total perioperative spending has become critical.


We retrospectively reviewed a private insurance claims database for patients that underwent single level PSF from January 2011 to December 2015. Patients were identified using CPT and ICD-9 CM/10 CM codes. Outpatient health services, prescription pain medications and inpatient hospital readmissions were assessed for their contribution to perioperative spending and utilization by patients. In addition, differences in spending among patients with different courses of postoperative care were assessed. All payments were inflation-adjusted to 2016 U.S Dollars using the Consumer Pricing Index.


25,401 patients (mean age 52 years, 58% female) were included in this study. Median spending during the period from 6 months prior to surgery to 6 months following surgery was $60,806 (IQR: $47,037 – 80,079) per patient. Preoperative spending, hospital admission and postoperative spending contributed 7%, 85% and 8%, respectively, towards total spending during the perioperative period. Median preoperative spending was $3,566 (IQR: $2,144 – 5,857) per patient, with imaging accounting for the highest proportion (33%) of preoperative spending. Postoperative spending differed between those readmitted and those who were not ($26,456 vs $1,304, p < 0.001). Readmission contributed to 42% of postoperative spending and 3.4% of total spending. The most utilized health services preoperatively and postoperatively were imaging, office visits and tests. Patients discharged to a rehabilitation facility incurred significantly higher spending postoperatively ($13,800) as compared to those discharged home ($1,778); home with home care ($2,937), and to another facility ($4,768) (p<0.001).


The perioperative period encompassing PSF incurs substantial cost to patients and payers. Postoperative readmission, including those admitted to a rehabilitation facility accounts for a significant portion of postoperative and total spending.

Clinical Implication

In addition to curtailing overall hospitalization costs, reducing hospital readmissions represents a considerable opportunity for cost reduction.


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