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Journal of Neurosurgical Sciences 2018 Sep 25

DOI: 10.23736/S0390-5616.18.04552-6

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Hospital complications and costs of spinal arteriovenous malformations in the United States from 2002-2014

John K. YUE 1, 2, Hansen DENG 1, 2, Ethan A. WINKLER 1, 2, Angel ORDAZ 1, 2, Eva M. GILLIS-BUCK 1, 2, Young M. LEE 1, 2, Michael M. SAFAEE 1, 2, Adib A. ABLA 1, Michael C. HUANG 1, 2, Sanjay S. DHALL 1, 2

1 Department of Neurological Surgery, University of California, San Francisco, CA, USA; 2 Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA


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BACKGROUND: Spinal arteriovenous malformations (AVMs) are rare disease entities with significant morbidity if untreated. Risk factors of complications, hospitalization and costs-of-care remain in need of characterization.
METHODS: Using the National Inpatient Sample years 2002-2014, adult subjects with spinal AVMs who underwent either laminectomy with lesion excision or endovascular embolization were extracted using ICD-9-CM diagnostic code 747.82. Predictors of inpatient complications, hospital length of stay (HLOS), and discharge home were evaluated using multivariable regression. Cost was evaluated using inflation- adjusted healthcare cost [charge*(cost/charge ratio)]. Mean differences (B), odds ratios (OR) and 95% CIs are reported. Significance was assessed at p<0.001.
RESULTS: In 2546 weighted admissions, age was 54.4±16.5-years (laminectomy: 70.0%, embolization: 30.0%). Fifteen-percent suffered inpatient complications. Cost of hospitalization was $41216±38511 and was elevated for subjects with complications ($67571±2636, vs. no complications: $36562±723, p<0.001). Increased costs for categories of complications ranged from $16525 (renal/urinary) to $62246 (thromboembolism). In surgical subjects, complications were more costly ($69761±2896, vs. no complications: 36520±809, p<0.001).
On multivariable analysis, major/extreme disease severity and major/extreme mortality risk were associated with increased complications and HLOS (p<0.001). Elective admissions had shorter HLOS (B=-4.3-days, [- 4.8, -3.8], p<0.001) and higher odds of discharge home (OR=2.6 [2.1-3.2], p<0.001). Laminectomy (vs. embolization) was associated with complications (OR=2.6, 95% CI [1.7-3.8], p<0.001), HLOS (B=3.4-days [2.9-4.0], p<0.001), and decreased discharge home (OR=0.3 [0.2-0.4], p<0.001).
CONCLUSIONS: In spinal AVMs, high disease severity, non-elective admissions, and surgery are associated with complications, HLOS, and discharge to a non-home facility. Costs are elevated in patients suffering complications. Future studies are warranted.


KEY WORDS: Charge-to-cost - Healthcare economics - Hospital cost - Inpatient complications - Outcomes - Spinal arteriovenous malformation

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