153 Significant Interhospital Variation in Cranial Surgery Costs Using the Nationwide Inpatient Sample Database. (August 2016)

• Record Type: Journal Article
• Authors: Zygourakis, Corinna Clio; Liu, Caterina; Theodosopoulos, Philip V.; Lawton, Michael T.; Dudley, Adams; Gonzales, Ralph
• Is Part Of: Clinical neurosurgery. Volume 63(2016)Supplement 1
• Publication Date: 2016-08
• Subjects: Nervous system -- Surgery -- Congresses; Neurosurgery; Nervous system -- Surgery; Neurologie; Congresses; Conference papers and proceedings; 617.48
• DOI: 10.1227/01.neu.0000489722.67573.19
• Languages: English
• ISSNs: 0069-4827

Abstract

Abstract : INTRODUCTION: Although several articles have shown variation in rates and costs of spinal procedures, there is a paucity of similar research in cranial neurosurgery. Our goal is to determine which factors underlie the variation in cost for the 2 most common intracranial neurosurgical diagnosis-related groups (DRGs): 025 (craniotomy and endovascular intracranial procedure with a major complication or comorbidity [MCC]) and 027 (craniotomy and endovascular intracranial procedure without a complication or comorbidity [CC]/MCC). METHODS: We obtained patient information (age, sex, race, severity of illness (SOI), risk of mortality (ROM), number of chronic conditions, payer, median zip code income), hospital data (region, teaching vs nonteaching, private vs government-owned, bed size, wage index), and admission information (elective vs emergent, length of stay [LOS]) for all patients with DRGs 025 (n = 12 293) or 027 (n = 11 344) in the 2013 Nationwide Inpatient Sample (NIS) database. We created multivariate regression models for each DRG to determine which patient, hospital, and admission-specific factors affect total cost. RESULTS: The mean costs (range) for DRGs 025 and 027 were $39 756 ($1869-$865 812) and $21 685 ($939-$222 466). Our multivariate model for DRG 025 showed that younger patient age, higher SOI, higher zip code income, longer LOS, higher wage index, private insurance, government-owned hospitals, and hospital region were significantly associated with higher cost ( P < .01). More specifically, government-owned private hospitals were $7055 more expensive than investor-owned private hospitals, and hospitals located in the Pacific United States were $9544 more expensive than those in New England. For DRG 027, we found that younger patient age, female sex, higher SOI higher ROM, greater number of chronic conditions, longer LOS, higher wage index, private insurance, and government-owned hospitals were associated with higher cost ( P < .01). CONCLUSION: Even after controlling for patient factors (age, risk of mortality, severity of illness) and wage index, geographic region (specifically, the Pacific region) and government hospital ownership are significantly associated with higher costs for DRGs 025 and 027.