Scoliosis, Unspecified Clinical Trial
Official title:
Single Versus Dual Spine Attending Surgeons in Complex Adult Deformity Surgery: A Cost-effectiveness Study Using Activity-based Costing
Two recent studies showed that having two attending spine surgeons performing complex adult
spine deformity surgery instead of one, decreased complications, unplanned surgeries within
30-days [Ames], 90-day readmissions, wound infection, pulmonary embolism/deep vein
thrombosis and post-operative neurologic complications [Sethi]. However, both studies were
retrospective and did not evaluate any cost-savings associated with having two spine
surgeons instead of one performing complex spine deformity surgery.
Most cost-effectiveness studies have used traditional accounting (TA) methods to determine
costs. A few cost-effectiveness studies have used time-driven activity-based costing (TDABC)
[Kaplan] in medicine [Au, Balakrishnan] and none in spine surgery.
Objectives: The objectives of the study are (1) to determine if dual spine attendings reduce
downstream costs compared to a single spine attending for complex spine surgeries using
traditional accounting methods; and (2) to demonstrate an application of the TDABC method to
evaluate the operating room phase during complex adult spinal deformity surgery and compare
it to traditional accounting methods (TA).
Two recent studies showed that having two attending spine surgeons performing complex adult
spine deformity surgery instead of one, decreased complications, unplanned surgeries within
30-days [Ames], 90-day readmissions, wound infection, pulmonary embolism/deep vein
thrombosis and post-operative neurologic complications [Sethi]. However, both studies were
retrospective and did not evaluate any cost-savings associated with having two spine
surgeons instead of one performing complex spine deformity surgery. With increasing scrutiny
on the efficient use of health care dollars, it would be important to determine if there are
any downstream cost savings to justify paying the surgeon fees of two spine attendings for
these complex and high cost cases.
Most cost-effectiveness studies have used traditional accounting (TA) methods to determine
costs. TA uses allocated expenses from the general ledger and payroll activity codes. These
codes are derived from billable items and procedures entered into accounting software. Costs
of services are grouped by cost types, across units of service.
A few cost-effectiveness studies have used time-driven activity-based costing (TDABC)
[Kaplan] in medicine [Au, Balakrishnan] and none in spine surgery. TDABC allows for detailed
identification of costs during all phases of a patient's care cycle. While TDABC has been
used in other industries, its use has been described only a few times in health care and
rarely in the operative setting [Balakrishnan]. This may be due to the large amount of
manpower necessary to collect TDABC data.
Objectives: The objectives of the study are (1) to determine if dual spine attendings reduce
downstream costs compared to a single spine attending for complex spine surgeries using
traditional accounting methods; and (2) to demonstrate an application of the TDABC method to
evaluate the operating room phase during complex adult spinal deformity surgery and compare
it to traditional accounting methods (TA).
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research