The Volume-Cost Relationship: How Does Surgical Volume Affect Cost and Value in AIS Surgery

Study Design: Retrospective review. Objective: The objective of this study was to evaluate and compare distribution of hospital and operating room charges and outcomes during posterior spinal fusion for adolescent idiopathic scoliosis (AIS) patients by high-volume (HV) and standard-volume (SV) surgeons at one institution and examine potential cost savings. Summary of Background Data: Increased surgical volume has been associated with improved perioperative outcomes after spinal deformity correction. However, there is a lack of information on how this may affect hospital costs. Methods: Retrospective study of AIS patients undergoing posterior spinal fusion between 2013 and 2019. Demographic, x-ray, chart review and hospital costs were collected and compared between HV surgeons (≥50 AIS cases/y) and SV surgeons (<50/y). Comparative analyses were computed using Wilcoxon rank-sum, Kruskal-Wallis, and the Fisher exact tests. Average values with corresponding minimum-maximum rages were reported. Results: A total of 407 patients (HV: 232, SV: 175) operated by 4 surgeons (1 HV, 3 SV). Radiographic parameters were similar between the groups. HV surgeons had significantly lower estimated blood loss (385.3 vs. 655.6 mL, P<0.001), fewer intraoperative transfusions (10.8% vs. 25.1%, P<0.001), shorter surgery time (221.6 vs. 324.9 min, P<0.001), and lower radiation from intraoperative fluoroscopy (4.4 vs. 6.4 mGy, P<0.001). HV patients had a significantly lower length of stay (4.3 vs. 5.3, P<0.001) and complication rate (0.4% vs. 4%, P=0.04). HV surgeons had significantly lower total costs ($61,716.24 vs. $72,745.93, P<0.001). This included lower transfusion costs (P<0.001), operative time costs (P<0.001), screw costs (P<0.001), hospital stay costs (P<0.001), and costs associated with 30-day emergency department returns (P<0.001). Conclusion: HV surgeons had significantly lower operative times, lower estimated blood loss and transfusion rates and lower perioperative complications requiring readmission or return to emergency department resulting in lower health care costs. Level of Evidence: Level III.