The purpose of this research was to compare the outcomes of posterior spinal fusion for patients with adolescent idiopathic scoliosis (AIS) between high-volume (HV) and standard-volume (SV) surgeons at a single institution to identify opportunities for cost reductions. 

The perioperative results of spinal deformity repair have been shown to improve with increasing surgical volume. There is, however, a need for more data on how this might affect the prices hospitals charge for their services. Therefore, studies of individuals with AIS who underwent posterior spinal fusion between 2013 and 2019 were analyzed retrospectively. There was a comparison made between HV surgeons (≥50 AIS cases/yr) and SV surgeons (<50/yr) based on collected demographic, x-ray, record review, and hospital charges data. 

The Wilcoxon rank-sum test, the Kruskal-Wallis test, and the Fisher exact test were used to conduct the statistical analysis. The median and range of data were reported, along with any outliers. There were 407 patients (407 HV, 232 SV) who were operated on by 4 surgeons (1 HV, 3 SV). The groups did not differ significantly in terms of radiographic characteristics. However, the estimated blood loss was significantly lower for HV surgeons (385.3 vs. 655.6 mL, P<0.001), as were the number of intraoperative transfusions (10.8% vs. 25.1%), the length of surgery (221.6 vs. 324.9 min, P<0.001), and the amount of radiation received from intraoperative fluoroscopy (4.4 vs. 6.4 mGy, P<0.001). 

Patients with HV stayed in the hospital for much less time than those without the virus (4.3 days vs. 5.3 days, P<0.001), and they experienced fewer complications (0.4 percent vs. 4 percent, P=0.04). As a result, the overall costs for HV surgeons were significantly lower than those of non-HV surgeons ($61,716.24 vs. $72,745.93, P<0.001). Expenses for transfusions (P<0.001), operations (P<0.001), screws (P<0.001), hospital days (P<0.001), and readmissions within 30 days (P<0.001) were all reduced. Health care expenses were reduced thanks to the shorter operating times, lower predicted blood loss and transfusion rates, and lower perioperative problems requiring readmission or a return to the emergency department that was seen by HV surgeons.

Source: journals.lww.com/jspinaldisorders/Abstract/2022/11000/The_Volume_Cost_Relationship__How_Does_Surgical.13.aspx