Research Fellow Thomas Jefferson University Hospital Philadelphia, Pennsylvania, United States
Introduction: Is there a significant difference in true (intraoperative) costs between anterior cervical fusions (ACDFs) and total disc replacement (TDR)? This information is critical as we move towards value-based purchasing. Therefore, we used time-driven activity-based costing (TDABC) to compare total intraoperative costs for the two procedures at a large academic institution.
Methods: Total cost was divided into direct (personnel and supply costs) and indirect costs (personnel and overhead costs). Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented, in conjunction with process mapping of the surgeries. Total intraoperative costs were estimated for all ACDFs and TDRs from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost.
Results: A total of 807 and 38 patients underwent one- and two-level ACDFs and TDRs, respectively. The average total intraoperative cost was $12,664 ± $4,202 for TDRs versus $6,763 ± $2,789 for ACDFs. Supply (82% for TDRs vs. 66% for ACDFs) and personnel costs (18% vs. 34%) were the major cost contributors. TDRs appeared to illustrate more variation in total supply costs, particularly implant costs ($8,540 ± $3,692 for TDRs vs. $3,145 ± $2,067 for ACDFs), while ACDFs seemingly exhibited more variation in personnel costs ($2,348 ± $908 for ACDFs vs. $2,350 ± $411 for TDRs). On linear regression analysis, patients with TDRs (β coefficient: $5,796 ± $484, p< 0.001) and age ≤ 50 years (p=0.02) had significantly higher total costs. TDRs (p=0.03), hypertensives (p=0.002), smokers (p=0.04), males (p=0.002), and patients aged ≤ 50 years (p=0.02) had significantly longer OR times.
Conclusion : TDABC is a feasible methodology for estimating differences in true intraoperative costs between TDRs and ACDFs. The major cost contributors were supply and personnel costs. TDRs appeared to illustrate more variation in total and supply costs while ACDFs seemingly displayed higher personnel cost variability. TDRs were associated with an additional $5,796 ± $484 of total intraoperative cost as compared to ACDFs. TDRs, hypertensives, smokers, males, and patients aged ≤ 50 years had significantly longer OR times.
