Reaching the medicare allowable threshold in adult spinal deformity surgery: multicenter cost analysis comparing actual direct hospital costs versus what the government will pay

2021 ◽  
Author(s):  
Jeffrey L. Gum ◽  
Breton Line ◽  
Leah Y. Carreon ◽  
Richard A. Hostin ◽  
Samrat Yeramaneni ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Hospital Costs ◽  
Spinal Deformity Surgery ◽  
The Government

Characteristics of false-positive alerts on transcranial motor evoked potential monitoring during pediatric scoliosis and adult spinal deformity surgery: an “anesthetic fade” phenomenon

2020 ◽  
Vol 32 (3) ◽  
pp. 423-431 ◽  
Author(s):  
Hiroki Ushirozako ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
False Positive ◽  
Adult Spinal Deformity ◽  
False Positive Rate ◽  
Multivariate Logistic Regression Analysis ◽  
Motor Evoked Potential ◽  
Scoliosis Surgery ◽  
True Negative ◽  
Duration Of Surgery ◽  
Spinal Deformity Surgery

OBJECTIVETranscranial motor evoked potential (TcMEP) monitoring may be valuable for predicting postoperative neurological complications with a high sensitivity and specificity, but one of the most frequent problems is the high false-positive rate. The purpose of this study was to clarify the differences in the risk factors for false-positive TcMEP alerts seen when performing surgery in patients with pediatric scoliosis and adult spinal deformity and to identify a method to reduce the false-positive rate.METHODSThe authors retrospectively analyzed 393 patients (282 adult and 111 pediatric patients) who underwent TcMEP monitoring while under total intravenous anesthesia during spinal deformity surgery. They defined their cutoff (alert) point as a final TcMEP amplitude of ≤ 30% of the baseline amplitude. Patients with false-positive alerts were classified into one of two groups: a group with pediatric scoliosis and a group with adult spinal deformity.RESULTSThere were 14 cases of false-positive alerts (13%) during pediatric scoliosis surgery and 62 cases of false-positive alerts (22%) during adult spinal deformity surgery. Compared to the true-negative cases during adult spinal deformity surgery, the false-positive cases had a significantly longer duration of surgery and greater estimated blood loss (both p < 0.001). Compared to the true-negative cases during pediatric scoliosis surgery, the false-positive cases had received a significantly higher total fentanyl dose and a higher mean propofol dose (0.75 ± 0.32 mg vs 0.51 ± 0.18 mg [p = 0.014] and 5.6 ± 0.8 mg/kg/hr vs 5.0 ± 0.7 mg/kg/hr [p = 0.009], respectively). A multivariate logistic regression analysis revealed that the duration of surgery (1-hour difference: OR 1.701; 95% CI 1.364–2.120; p < 0.001) was independently associated with false-positive alerts during adult spinal deformity surgery. A multivariate logistic regression analysis revealed that the mean propofol dose (1-mg/kg/hr difference: OR 3.117; 95% CI 1.196–8.123; p = 0.020), the total fentanyl dose (0.05-mg difference; OR 1.270; 95% CI 1.078–1.497; p = 0.004), and the duration of surgery (1-hour difference: OR 2.685; 95% CI 1.131–6.377; p = 0.025) were independently associated with false-positive alerts during pediatric scoliosis surgery.CONCLUSIONSLonger duration of surgery and greater blood loss are more likely to result in false-positive alerts during adult spinal deformity surgery. In particular, anesthetic doses were associated with false-positive TcMEP alerts during pediatric scoliosis surgery. The authors believe that false-positive alerts during pediatric scoliosis surgery, in particular, are caused by “anesthetic fade.”

scholarly journals Variability in Hospital Costs of Adult Spinal Deformity Care

Spine ◽  
2020 ◽  
Vol 45 (17) ◽  
pp. 1221-1228
Author(s):  
Karel Jacobs ◽  
Thibault Dewilde ◽  
Cindy Vandoren ◽  
Brecht Cardoen ◽  
Nancy Vansteenkiste ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Hospital Costs

P86. Impact of reoperations on cost of care in adult spinal deformity surgery

2021 ◽  
Vol 21 (9) ◽  
pp. S182
Author(s):  
Samrat Yeramaneni ◽  
Kevin Wang ◽  
Breton Line ◽  
Amit Jain ◽  
Brian J. Neuman ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Cost Of Care ◽  
Spinal Deformity Surgery

234. Neurologic complications after adult spinal deformity surgery

2021 ◽  
Vol 21 (9) ◽  
pp. S120
Author(s):  
Michael Dinizo ◽  
Karnmanee Srisanguan ◽  
Thomas J. Errico ◽  
Tina Raman
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Neurologic Complications ◽  
Spinal Deformity Surgery

A Systematic Review of Risk Factors Associated With Distal Junctional Failure in Adult Spinal Deformity Surgery

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Jake M. McDonnell ◽  
Daniel P. Ahern ◽  
Scott C. Wagner ◽  
Patrick B. Morrissey ◽  
Ian D. Kaye ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Factors Associated ◽  
Spinal Deformity Surgery

scholarly journals Proximal Junctional Kyphosis and Proximal Junctional Failure Following Adult Spinal Deformity Surgery

2017 ◽  
Vol 14 (4) ◽  
pp. 126-132 ◽  
Author(s):  
Seung-Jae Hyun ◽  
Byoung Hun Lee ◽  
Jong-Hwa Park ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Proximal Junctional Kyphosis ◽  
Spinal Deformity Surgery ◽  
Proximal Junctional Failure ◽  
Junctional Kyphosis

Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery

Spine ◽  
2019 ◽  
Vol 44 (4) ◽  
pp. 263-269 ◽  
Author(s):  
Ravi Verma ◽  
Renaud Lafage ◽  
Justin Scheer ◽  
Justin Smith ◽  
Peter Passias ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Leg Pain ◽  
Spinal Deformity Surgery
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