Patterns of healthcare resource utilization prior to anterior cervical decompression and fusion in patients with radiculopathy

Objective To assess patterns of healthcare resource utilization prior to anterior cervical decompression and fusion (ACDF) in patients diagnosed with radiculopathy with a retrospective cohort study design.

Background ACDF is associated with improvement in quality of life among patients with cervical radiculopathy. However, little is known regarding utilization of healthcare services and total cost of care before ACDF surgery in the United States.

Methods We analyzed a group of patients who received ACDF for radiculopathy during 2009-2011 using a healthcare database of over 20 million patients of all ages. Patients with fewer than two years of data prior to ACDF procedure were excluded. Inclusion criteria included patients with a diagnosis of disc displacement/degeneration and radiculopathy. All charges related to healthcare administration within two years prior to surgery were recorded and analyzed.

Results Sixteen hundred seventy six patients met the inclusion criteria. Seventy-three percent of patients were in the 40-59 year age range; 55% were women and 45% were men. In the two years preceding the surgery, 34% of patients received prescription NSAIDs, and 98% received prescription narcotics for total charges of $101,188 ($174.46/patient) and $222,860 ($134.82/patient) respectively. Total pain-related interventions over two years (oral pharmacotherapy and injections) were charged at $4,368,900 at an average of $2,606/treatment. Total outpatient charges including physician office visits, other outpatient visits and emergency room visits amounted to $25,450,012. Mean total outpatient charges over the two years preceding ACDF was $15,556 per patient for 26,397 episodes of care. Injectable corticosteroids were provided for 84.7% of patients and charges related to this treatment totaled $1,137 per patient.

Conclusions In the two years prior to ACDF, healthcare resource utilization is extremely high. Given that these patients ultimately undergo surgical intervention, opportunities to reduce charges of conservative care exist.