Study Design/Setting: 

Retrospective.

Objective: 

To understand differences in 30-day outcomes between patients undergoing posterior cervical fusion (PCF) for fracture versus degenerative cervical spine disease.

Summary of Background Data: 

Current bundled payment models for cervical fusions, such as the Bundled Payments for Care Improvement revolve around the use of diagnosis-related groups to categorize patients for reimbursement purposes. Though a PCF performed for a fracture may have a different postoperative course of care as compared with a fusion being done for degenerative cervical spine pathology, the current DRG system does not differentiate payments based on the indication/cause of surgery.

Methods: 

The 2012-2017 American College of Surgeons–National Surgical Quality Improvement Program was queried using Current Procedural Terminology code 22600 to identify patients receiving elective PCFs. Multivariate analyses were used to compare rates of 30-day severe adverse events, minor adverse events, readmissions, length of stay, and nonhome discharges between the 2 groups.

Results: 

A total 2546 (91.4%) PCFs were performed for degenerative cervical spine pathology and 240 (8.6%) for fracture. After adjustment for differences in baseline clinical characteristics, patients undergoing a PCF for a fracture versus degenerative pathology had higher odds of severe adverse events [18.8% vs. 10.6%, odds ratio (OR): 1.65 (95% CI, 1.10–2.46); P=0.015], prolonged length of stay >3 days [54.2% vs. 40.5%, OR: 1.93 (95% CI, 1.44–2.59); P<0.001], and nonhome discharges [34.2% vs. 27.6%, OR: 1.54 (95% CI, 1.10–2.17); P=0.012].

Conclusions: 

Patients undergoing PCFs for fracture have significant higher rates of postoperative adverse events and greater resource utilization as compared with individuals undergoing elective PCF for degenerative spine pathology. The study calls into question the need of risk adjustment of bundled prices based on indication/cause of the surgery to prevent the creation of a financial disincentive when taking care/performing surgery in spinal trauma patients.

中文翻译：

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骨折后路颈椎融合术与退行性颈椎病融合术不同：对捆绑支付模式的影响

研究设计/设置： 

回顾性的。

客观的： 

了解接受颈椎后路融合术 (PCF) 治疗的骨折患者与退行性颈椎病患者 30 天结果的差异。

背景数据摘要： 

目前用于宫颈融合术的捆绑支付模式，例如护理改进捆绑支付，围绕着使用诊断相关组对患者进行分类以实现报销目的。尽管与针对退行性颈椎病变进行的融合相比，针对骨折进行的 PCF 可能具有不同的术后护理过程，但当前的 DRG 系统并未根据手术的适应症/原因区分付款。

方法： 

使用当前程序术语代码 22600 查询 2012-2017 年美国外科医师学会国家外科质量改进计划，以确定接受选择性 PCF 的患者。多变量分析用于比较两组之间 30 天严重不良事件、轻微不良事件、再入院率、住院时间和非家庭出院率。

结果： 

共进行了 2546 次（91.4%）PCF 用于颈椎退行性病变，240 次（8.6%）用于骨折。调整基线临床特征差异后，与退行性病变相比，因骨折而接受 PCF 的患者发生严重不良事件的几率更高 [18.8% 对 10.6%，优势比 (OR)：1.65（95% CI，1.10–2.46） ; P = 0.015]，住院时间延长 > 3 天 [54.2% 对 40.5%，OR：1.93（95% CI，1.44–2.59）；P <0.001] 和非家庭出院率 [34.2% 对 27.6%，或：1.54（95% CI，1.10–2.17）；P = 0.012]。

结论： 

与接受选择性 PCF 治疗退行性脊柱病变的患者相比，因骨折接受 PCF 治疗的患者术后不良事件发生率明显更高，资源利用率更高。该研究质疑是否需要根据手术的适应症/原因对捆绑价格进行风险调整，以防止在对脊柱外伤患者进行护理/进行手术时产生财务抑制因素。