Study Design: 

Retrospective cohort study.

Objective: 

The aim was to compare 90-day and 2-year reimbursements for ≥2-level anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), posterior laminectomy and fusion (LF) and laminoplasty (LP) done for degenerative cervical myelopathy (DCM).

Summary of Background Data: 

In DCM pathologies where there exists a clinical equipoise in approach selection, a randomized controlled trial found that an anterior approach did not significantly improve patient-reported outcomes over posterior approaches. In the era of value and bundled payments initiatives, cost profile of various approaches will form an important consideration for decision making.

Materials and Methods: 

IBM MarketScan Research Database (2005–2018) was used to study beneficiaries (30–75 y) who underwent surgery (mACDF, ACCF, LF, LP) for DCM. Index hospital stay (operating room, surgeon, hospital services) and postdischarge inpatient, outpatient and prescription medication payments have been used to simulate 90-day and 2-year bundled payment amounts, along with their distribution for each procedure.

Results: 

A total of 10,834 patients with median age of 54 years were included. The median 90-day payment was $46,094 (interquartile range: $34,243–$65,841) for all procedures, with LF being the highest ($64,542) and LP the lowest ($37,867). Index hospital was 62.4% (operating room: 46.6) and surgeon payments were 17.5% of the average 90-day bundle. There was significant difference in the index, 90-day and 2-year reimbursements and their distribution among procedures.

Conclusion: 

In a national cohort of patients undergoing surgery for DCM, LP had the lowest complication rate, and simulated bundled reimbursements at 90 days and 2 years postoperatively. The lowest quartile 90-day payment for LF was more expensive than median amounts for mACDF, ACCF, and LP. If surgeons encounter scenarios of clinical equipoise in practice, LP is likely to result in maximum value as it is on an average 70% less expensive than LF over 90 days.

中文翻译：

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治疗退行性脊髓型颈椎病的 4 种常见手术方法的模拟捆绑支付：打破临床平衡的考虑

 学习规划：

回顾性队列研究。

 客观的：

目的是比较 ≥2 节段前路颈椎间盘切除融合术 (mACDF)、前路颈椎椎体切除融合术 (ACCF)、后路椎板切除融合术 (LF) 和椎板成形术 (LP) 的 90 天和 2 年报销退行性脊髓型颈椎病（DCM）。

背景数据摘要：

在入路选择方面存在临床均衡的 DCM 病理中，一项随机对照试验发现前路入路并没有显着改善患者报告的结果。在价值和捆绑支付举措时代，各种方法的成本状况将成为决策的重要考虑因素。

 材料和方法：

IBM MarketScan 研究数据库 (2005-2018) 用于研究因 DCM 接受手术（mACDF、ACCF、LF、LP）的受益人（30-75 岁）。指数住院时间（手术室、外科医生、医院服务）和出院后住院、门诊和处方药付款已用于模拟 90 天和 2 年捆绑付款金额，以及每次手术的分配情况。

 结果：

总共纳入了 10,834 名患者，中位年龄为 54 岁。所有手术的 90 天付款中位数为 46,094 美元（四分位数范围：34,243 美元至 65,841 美元），其中 LF 最高（64,542 美元），LP 最低（37,867 美元）。医院指数为 62.4%（手术室：46.6），外科医生费用占平均 90 天捆绑费用的 17.5%。指数、90 天和 2 年报销及其在程序之间的分布存在显着差异。

 结论：

在接受 DCM 手术的全国患者队列中，LP 的并发症发生率最低，并在术后 90 天和术后 2 年进行模拟捆绑报销。 LF 的最低四分位数 90 天付款比 mACDF、ACCF 和 LP 的中位数要贵。如果外科医生在实践中遇到临床平衡的情况，LP 可能会产生最大价值，因为在 90 天内，LP 平均比 LF 便宜 70%。