Hospital Costs for Surgical Treatment of Adolescent Idiopathic Scoliosis Rise Dramatically

Hospital costs for posterior spinal fusion (PSF), the most common
surgical treatment associated with adolescent idiopathic scoliosis (AIS), has
increased by more than 100% from 1997 to 2006, a study found. Charles T.
Mehlman, DO, MPH, director of musculoskeletal outcomes research at Cincinnati
Children’s Hospital Medical Center, presented his findings at the
Annual Meeting of the American Academy of Orthopaedic

“Even controlling for inflation, the total costs increased
substantially,” Mehlman told O&P Business News. “If
you convert the costs into 1997 dollars, the surgery costs increased from
$31,000 an operation to $74,000 an operation by 2006. By the same token, if we
converted the costs to 2006 dollars, surgery costs increased from $41,000 an
operation to $93,000.”

Mehlman used the Kids’ Inpatient Database (KID) to capture the
costs of AIS procedures. KID, a large publically available national subset of
the Healthcare Cost and Utilization Project (HCUP), gathered data reported by
hospitals during the years 1997, 2000, 2003 and 2006. The database has grown
substantially since 1997. Initially, 22 states contributed to the database. By
2006, 38 states were contributing information. A total of 9,013 patients
underwent PSF during the years studied.

According to Mehlman, he and his colleagues only examined those AIS
patients that most scoliosis surgeons would consider simple cases.

  Source: Kids’ Inpatient

“We made special efforts in our study to eliminate patents if they
looked like a complicated case,” Mehlman explained. “If the child had
any other diagnosis besides AIS, we excluded them. If they stayed in the
hospital for more than 2 weeks, we defined that as a complicated case and we
excluded that as well.”

Mehlman admitted that the study is at the mercy of one large database.
The database only indicated the considerable cost increases associated with
AIS. One of the challenges for Mehlman is to ascertain the reasons behind the
increase in costs. Aspects of scoliosis care have become more expensive.
According to Mehlman, spinal instrumentation such as hooks, screws and rods, as
well as spinal cord monitoring technology has improved and but has also become
more expensive.

“The database does not offer all the details you might want,”
Mehlman said. “What we know is that over those same 10 years, nothing else
about scoliosis is 100% better. The children are not 100% straighter. The
surgery is not 100% safer and the blood loss is not 100% lower. All we know for
sure is that the same sort of treatment has gotten 100% more expensive.”

There are numerous studies, according to Mehlman that suggest that more
expensive systems do not necessarily mean they are better. This could be a
contributing factor to the substantial rise in costs and one the health care
industry hopes to avoid in the future.

“We are not looking to have the same result that is more
expensive,” Mehlman concluded. “How about the same result that is
less expensive? It is possible.” — by Anthony Calabro

For more information:

  • Melhman, CT. Hospital costs associated with surgical treatment of
    adolescent idiopathic scoliosis. Paper #181. Presented at the 2010 Annual
    Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New


Posterior spinal fusion has been the primary surgical treatment for AIS
for a number of years. The devices and instrumentation available to correct
curvature of the spine have continued to improve. The increased usage of
pedicle screws has resulted in greater correction of curvatures, but has also
resulted in rising costs.

The number of implants used in each patient, along with the transition
from all hook constructs to all screw constructs, has also led to higher costs
for surgical treatment. But as we improve spinal curvatures, are the outcomes
for patients better because of the ability of those implants?

Mehlman also discussed complicated cases. I think it is difficult to
determine what is and what is not a complicated case. The use of the term
“complicated” is broad. Each surgeon may view complications
differently. It depends on the practice each surgeon has.

But the more pressing concern and the question physicians must ask
themselves is does the outcome of the patient justify the increase in costs? I
think that is the fundamental issue.

— Stuart L. Weinstein, MD
Professor of
orthopaedic surgery, University of Iowa Hospitals and Clinics

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