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Retrospective cost analysis of cervical laminectomy and fusion versus cervical laminoplasty in the treatment of cervical spondylotic myelopathy

Daniel T. Warren, MD,1 Pedro A. Ricart-Hoffiz, MD,2 Tate M. Andres, BS,3 Christian M. Hoelscher, BS,3 Themistocles S. Protopsaltis, MD,3 Jeffrey A. Goldstein, MD,3 John A. Bendo, MD3

1Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada 2Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 3Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY

Abstract 

Background

Cervical laminoplasty (CLP) and posterior cervical laminectomy and fusion (CLF) are well-established surgical procedures used in the treatment of cervical spondylotic myelopathy (CSM). In situations of clinical equipoise, an influential factor in procedural decision making could be the economic effect of the chosen procedure. The object of this study is to compare and analyze the total hospital costs and charges pertaining to patients undergoing CLP or CLF for the treatment of CSM.

Methods

We performed a retrospective review of 81 consecutive patients from a single institution; 55 patients were treated with CLP and 26 with CLF. CLP was performed via the double-door allograft technique that does not require implants, whereas laminectomy fusion procedures included metallic instrumentation. We analyzed 10,682 individual costs (HC) and charges (HCh) for all patients, as obtained from hospital accounting data. The Current Procedural Terminology codes were used to estimate the physicians' fees as such fees are not accounted for via hospital billing records. Total cost (TC) therefore equaled the sum of the hospital cost and the estimated physicians' fees.

Results

The mean length of stay was 3.7 days for CLP and 5.9 days for CLF (P < .01). There were no significant differences between the groups with respect to age, gender, previous surgical history, and medical insurance. The TC mean was $17,734 for CLP and $37,413 for CLF (P < .01). Mean HCh for CLP was 42% of that for CLF, and therefore the mean charge for CLF was 238% of that for CLP (P < .01). Mean HC was $15,426 for CLP and $32,125 for CLF (P < .01); the main contributor was implant cost (mean $2582).

Conclusions

Our study demonstrates that, in clinically similar populations, CLP results in reduced length of stay, TC, and hospital charges. In CSM cases requiring posterior decompression, we demonstrate CLP to be a less costly procedure. However, in the presence of neck pain, kyphotic deformity, or gross instability, this procedure may not be sufficient and posterior CLF may be required.

keywords: 
Cervical laminoplasty, Cervical laminectomy and fusion, Cost comparison, Hospital cost
Volume 7
doi: 
10.1016/j.ijsp.2013.04.001