Volume-Cost Relationship in Neurosurgery: Analysis of 12,129,029 Admissions from the National Inpatient Sample

Authors

James S. Yoon, Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Yale School of Medicine, New Haven, Connecticut, USA.Follow
Oliver Y. Tang, Brown University, Providence, Rhode Island, USA.
Michael T. Lawton, Department of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: michael.lawton@barrowbrainandspine.com.Follow

Document Type

Article

Abstract

BACKGROUND/OBJECTIVE: Several studies have documented improved outcomes at high-volume hospitals for neurosurgery. However, the relationship between neurosurgical volume and costs remains poorly understood. METHODS: Using neurosurgery-specific Diagnosis-Related Groups (DRG) codes, we identified adult neurosurgical admissions in the National Inpatient Sample from 2002 to 2014. We stratified hospitals by annual neurosurgical volume as high-volume (top 20%) or low-volume centers (bottom 80%). We performed survey-weighted regression analyses to examine the impact of case volume on inpatient costs. RESULTS: A total of 12,129,029 admissions underwent neurosurgery from 2002 to 2014, with 59.6% treated at high-volume hospitals. Patients at high-volume centers were more likely to have private insurance, higher risk of mortality scores, and higher DRG weight procedures than those at low-volume centers (P < 0.001). High-volume hospital admissions were on average 9% or $1791 more expensive than their low-volume counterparts. However, after adjustment for patient, hospital, and case-mix differences, high-volume hospitals were 4.3% less expensive than low-volume centers ($21,825 vs. $22,924; P < 0.01). The southern United States, which had the biggest volume, showed the highest savings (6.5%). CONCLUSIONS: High-volume hospitals provide more cost-effective neurosurgical care. Centralization of care at high-volume neurosurgical institutions may be a promising strategy to delivering higher-value care, achieving better outcomes at lower costs.

Medical Subject Headings

Hospitalization (economics); Hospitals, High-Volume; Humans; Inpatients; Length of Stay (economics); Neurosurgical Procedures (economics); United States

Publication Date

6-17-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

129

First Page

e791

Last Page

e802

PubMed ID

31203075

Digital Object Identifier (DOI)

10.1016/j.wneu.2019.06.034

Recommended Citation

Yoon, James S.; Tang, Oliver Y.; and Lawton, Michael T., "Volume-Cost Relationship in Neurosurgery: Analysis of 12,129,029 Admissions from the National Inpatient Sample" (2019). Neurosurgery. 1349.
https://scholar.barrowneuro.org/neurosurgery/1349