Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma
Introduction: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase. Research question: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondar...
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529424000365 |
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| author | Omar H. Tarawneh Rajkishen Narayanan Michael McCurdy Tariq Z. Issa Yunsoo Lee Olivia Opara Nicholas B. Pohl Alexa Tomlak Matthew Sherman Jose A. Canseco Alan S. Hilibrand Alexander R. Vaccaro Gregory D. Schroeder Christopher K. Kepler |
| author_facet | Omar H. Tarawneh Rajkishen Narayanan Michael McCurdy Tariq Z. Issa Yunsoo Lee Olivia Opara Nicholas B. Pohl Alexa Tomlak Matthew Sherman Jose A. Canseco Alan S. Hilibrand Alexander R. Vaccaro Gregory D. Schroeder Christopher K. Kepler |
| author_sort | Omar H. Tarawneh |
| collection | DOAJ |
| description | Introduction: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase. Research question: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care. Materials and methods: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60–69(sexagenarians), 70–79(septuagenarians) and 80–89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition. Results: A total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = −0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73–1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81–3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility. Discussion and conclusions: Healthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued. |
| format | Article |
| id | doaj-art-d7ffa9c8db7d4175b1ad1c8ef2ee703f |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-d7ffa9c8db7d4175b1ad1c8ef2ee703f2024-12-15T06:18:15ZengElsevierBrain and Spine2772-52942024-01-014102780Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar traumaOmar H. Tarawneh0Rajkishen Narayanan1Michael McCurdy2Tariq Z. Issa3Yunsoo Lee4Olivia Opara5Nicholas B. Pohl6Alexa Tomlak7Matthew Sherman8Jose A. Canseco9Alan S. Hilibrand10Alexander R. Vaccaro11Gregory D. Schroeder12Christopher K. Kepler13Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USACorresponding author. Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.; Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USADepartment of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USAIntroduction: As the population of elderly patients continues to rise, the number of these individuals presenting with thoracolumbar trauma is expected to increase. Research question: To investigate thoracolumbar fusion outcomes for patients with vertebral fractures as stratified by decade. Secondarily, we examined the variability of cost across age groups by identifying drivers of cost of care. Materials and methods: We queried the United States Nationwide Inpatient Sample(NIS) for adult patients undergoing spinal fusion for thoracolumbar fractures between 2012 and 2017. Patients were stratified by decade 60–69(sexagenarians), 70–79(septuagenarians) and 80–89(octogenarians). Bivariable analysis followed by multivariable regression was performed to assess independent predictors of length of stay(LOS), hospital cost, and discharge disposition. Results: A total of 2767 patients were included, of which 46%(N = 1268) were sexagenarians, 36% septuagenarians and 18%(N = 502) octogenarians. Septuagenarians and octogenarians had shorter LOS compared to sexagenarians(ß = −0.88 days; p = 0.012) and(ß = -1.78; p < 0.001), respectively. LOS was reduced with posterior approach(-2.46 days[95% CI: 3.73–1.19]; p < 0.001), while Hispanic patients had longer LOS(+1.97 [95% CI: 0.81–3.13]; p < 0.001). Septuagenarians had lower total charges $12,185.70(p = 0.040), while the decrease in charges in octogenarians was more significant, with a decrease of $26,016.30(p < 0.001) as compared to sexagenarians. Posterior approach was associated with a decrease of $24,337.90 in total charges(p = 0.026). Septuagenarians and octogenarians had 1.72 higher odds(p < 0.001) and 4.16 higher odds(p < 0.001), respectively, of discharge to a skilled nursing facility. Discussion and conclusions: Healthcare utilization in geriatric thoracolumbar trauma is complex. Cost reductions in the acute hospital setting may be offset by unaccounted costs after discharge. Further research into this phenomenon and observed racial/ethnic disparities must be pursued.http://www.sciencedirect.com/science/article/pii/S2772529424000365Thoracolumbar traumaFractureAgeGeriatricCost |
| spellingShingle | Omar H. Tarawneh Rajkishen Narayanan Michael McCurdy Tariq Z. Issa Yunsoo Lee Olivia Opara Nicholas B. Pohl Alexa Tomlak Matthew Sherman Jose A. Canseco Alan S. Hilibrand Alexander R. Vaccaro Gregory D. Schroeder Christopher K. Kepler Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma Brain and Spine Thoracolumbar trauma Fracture Age Geriatric Cost |
| title | Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| title_full | Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| title_fullStr | Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| title_full_unstemmed | Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| title_short | Evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| title_sort | evaluation of perioperative care and drivers of cost in geriatric thoracolumbar trauma |
| topic | Thoracolumbar trauma Fracture Age Geriatric Cost |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424000365 |
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