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Research ArticleLumbar Spine

A 5-Year Review of Hospital Costs and Reimbursement in the Surgical Management of Degenerative Spondylolisthesis

Keith W. Lyons, Christian M. Klare, Samuel T. Kunkel, Jason R. Lemire, Mike Bao, Kevin J. McGuire, Adam M. Pearson and William A. Abdu
International Journal of Spine Surgery August 2019, 6052; DOI: https://doi.org/10.14444/6052
Keith W. Lyons
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD
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Christian M. Klare
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD
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Samuel T. Kunkel
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD, MS
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Jason R. Lemire
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MPH FACHE
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Mike Bao
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
BS
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Kevin J. McGuire
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD, MS
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Adam M. Pearson
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD, MS
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William A. Abdu
Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire
MD, MS
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ABSTRACT

Background To evaluate charges, expenses, reimbursement, and hospital margins with noninstrumented posterolateral fusion in situ (PLF), posterolateral fusion with pedicle screws (PPS), and PPS with interbody device (PLIF) in degenerative spondylolisthesis with spinal stenosis.

Methods A retrospective chart review was performed from 2010 to 2014 based on ICD-9 diagnoses of degenerative spondylolisthesis with spinal stenosis in patients undergoing single-level fusions. All charges, expenses, reimbursement, and margins were obtained through financial auditing. A multivariate linear regression model was used to compare demographics, charges, etc. A 1-way analysis of variance with Tukey post hoc analysis was used to analyze reimbursements and margins based upon insurances.

Results Two hundred thirty-three patients met inclusion criteria. The overall charges and expenses for PLF were significantly less compared to both types of instrumented fusions (P < .0001). Medicare and private insurance were the most common insurance types; Medicare and private insurance mean reimbursements for PLF were $36,903 and $47,086, respectively; for PPS, $37,450 and $53,851, and for PLIF $40,171 and $51,640. Hospital margins for PPS and PLIF in Medicaid patients were negative (−$3,702 and −$6,456). Hospital margins were largest for both worker's compensation and private insurance patients in all fusion groups. Hospital margins with Medicare for PLF, PPS, and PLIF were $24,347, $19,205, and $23,046, respectively. Hospital margins for private insurance for PLF, PPS, and PLIF were $37,569, $36,834, and $33,134, respectively.

Conclusions As more instrumentation is used, the more it costs both the hospital and the insurance companies; hospital margins did not increase correspondingly.

Clinical Relevance Improved understanding of related costs and margins associated with lumbar fusions to help transition to more cost effective spine centers.

  • degenerative spondylolisthesis
  • reimbursement
  • hospital cost

Footnotes

  • Disclosures and COI: Dartmouth College Institutional Review Board Approval, CPHS no. 00024098.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery
Vol. 19, Issue 3
1 Jun 2025
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A 5-Year Review of Hospital Costs and Reimbursement in the Surgical Management of Degenerative Spondylolisthesis
Keith W. Lyons, Christian M. Klare, Samuel T. Kunkel, Jason R. Lemire, Mike Bao, Kevin J. McGuire, Adam M. Pearson, William A. Abdu
International Journal of Spine Surgery Aug 2019, 6052; DOI: 10.14444/6052

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A 5-Year Review of Hospital Costs and Reimbursement in the Surgical Management of Degenerative Spondylolisthesis
Keith W. Lyons, Christian M. Klare, Samuel T. Kunkel, Jason R. Lemire, Mike Bao, Kevin J. McGuire, Adam M. Pearson, William A. Abdu
International Journal of Spine Surgery Aug 2019, 6052; DOI: 10.14444/6052
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