The Impact of Single-Vendor Procurement of Spinal Implants: An Analysis of Cost Savings and Surgical Quality at an Academic Hospital. (1st September 2019)

• Record Type: Journal Article
• Authors: Blackburn, Collin; Thompson, Nicolas; Tanenbaum, Joseph E; Mroz, Thomas E; Steinmetz, Michael P
• Is Part Of: Neurosurgery. Volume 66(2010)Supplement 1
• Publication Date: 2019-09-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz310_159
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: In 2011, our institution abandoned a multi-vendor strategy of purchasing commodity spinal implants, such as pedicle screws and plates, in favor of a dual-vendor model. In 2015, facing ongoing budgetary constraints, we advanced to a sole supplier of these devices. The objective of this study was to report the savings created by the dual-vendor and single-vendor purchasing of spinal implants, and to assess whether vendor rationalization affected the quality-of-care at our institution. METHODS: Patients receiving single-level lumbar interbody fusion (CPT# 22630, 22633) at our institution between January 1, 2008 and July 31, 2017 were identified retrospectively. Patients were excluded if they had a multi-level fusion, prior instrumentation, or anterior fusion. Patients were grouped according to the number of vendors available to our surgeons at the time of the patient's surgery; the 2008 to 2010, 2011 to 2014, and 2015 to 2017 time periods were defined as the multi-vendor (10 vendors), dual-vendor, and single-vendor periods, respectively. Propensity score weighting was performed to control for potential confounding between the patient cohorts. Outcomes were defined as rates of 12-mo revision surgeries and patient-reported outcomes, as measured by EQ-5D/PROMIS-GH utilities. Annual cost savings associated with the dual-vendor and single-vendor periods are also reported. RESULTS: A total of 1373 patients were analyzed. Rates of revision surgeries after propensity score weighting were 3.2%, 4.5%, and 3.0% for the multi-vendor (Neff = 177.2), dual-vendor (Neff = 546.6), and single-vendor periods (Neff = 418.2), respectively. Revision surgeries ( P < .01) and EQ-5D/PROMIS-GH utilities ( P < .01) were statistically equivalent across all three time periods and no association between purchasing and the quality-of-care was observed. The annual cost savings directly attributable to vendor rationalization were 24% and 21% for the dual-vendor and single-vendor periods, respectively. CONCLUSION: The dual-vendor and single-vendor procurement of spinal implants resulted in significant cost savings for our institution without evidence of a detrimental impact on the quality-of-care provided.