Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients

• Published in: Journal of neurosurgery. Pediatrics Vol. 16; no. 3; pp. 322 - 328
• Main Authors: Vigneswaran, Hari T, Grabel, Zachary J, Eberson, Craig P, Palumbo, Mark A, Daniels, Alan H
• Format: Journal Article
• Language: English
• Published: United States 01-09-2015
• Subjects: Adolescent; Child; Child, Preschool; Comorbidity; Cost of Illness; Female; Hospital Charges; Humans; Infant; Insurance Coverage; Insurance, Health; International Classification of Diseases; Length of Stay; Linear Models; Male; Odds Ratio; Retrospective Studies; Scoliosis - diagnosis; Scoliosis - economics; Scoliosis - epidemiology; Scoliosis - surgery; Spinal Fusion; United States - epidemiology; Young Adult; United States; AHRQ = Agency for Healthcare Research and Quality; pedicle screw; AIS = adolescent idiopathic scoliosis; pediatric spinal surgery; complications; KID = Kids’ Inpatient Database; scoliosis; HCUP = Healthcare Cost and Utilization Project; spine; hospital charge; LOS = length of stay
• ISSN: 1933-0707; 1933-0715
• DOI: 10.3171/2015.3.PEDS14649

Adolescent idiopathic scoliosis (AIS) can cause substantial morbidity and may require surgical intervention. In this study, the authors aimed to evaluate US trends in operative AIS as well as patient comorbidities, operative approach, in-hospital complications, hospital length of stay (LOS), and hospital charges in the US for the period from 1997 to 2012.
Patients with AIS (ICD-9-CM diagnosis codes 737.30) who had undergone spinal fusion (ICD-9-CM procedure codes 81.xx) from 1997 to 2012 were identified from the Kids' Inpatient Database. Parameters of interest included patient comorbidities, operative approach (posterior, anterior, or combined anteroposterior), in-hospital complications, hospital LOS, and hospital charges.
The authors identified 20, 346 patients in the age range of 0-21 years who had been admitted for AIS surgery in the defined study period. Posterior fusions composed 63.4% of procedures in 1997 and 94.1% in 2012 (r = 0.95, p < 0.01). The mean number of comorbidities among all fusion groups increased from 3.0 in 1997 to 4.2 in 2012 (r = 0.92, p = 0.01). The percentage of patients with complications increased from 15.6% in 1997 to 22.3% in 2012 (r = 0.78, p = 0.07). The average hospital LOS decreased from 6.5 days in 1997 to 5.6 days in 2012 (r = -0.86, p = 0.03). From 1997 to 2012, the mean hospital charges (adjusted to 2012 US dollars) for surgical treatment of AIS more than tripled from $55,495 in 1997 to $177,176 in 2012 (r = 0.99, p < 0.01).
Over the 15-year period considered in this study, there was an increasing trend toward using posterior-based techniques for AIS corrective surgery. The number of comorbid conditions per patient and thus the medical complexity of patients treated for AIS have increased. The mean charges for the treatment of AIS have increased, with a national bill over $1.1 billion per year in 2012.