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Sethi R, Louie P, Bansal A, Gilbert M, Nemani V, Leveque JC, Drolet CE, Ohlson B, Kronfol R, Strunk J, Cornett-Gomes K, Friedman A, LeFever D. Monthly multidisciplinary complex spine conference: a cost-analysis utilizing time-driven activity-based costing. Spine Deform 2024; 12:433-442. [PMID: 38103094 DOI: 10.1007/s43390-023-00798-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/18/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE To understand costs and provide an initial framework associated with conference implementation as it pertains to complication prevention. METHODS Team members' time spent on conference preparation, presentation, and follow-up tasks was recorded and averaged to determine the time required to prepare and present one patient. Using 2022 hourly wage rates based on our urban hospital setting, wage values were calculated for each personnel type and applied to their time spent. The total cost of the conference was annualized and calculated from the time spent in the three phases of the conference multiplied by the wage rate. Published data on complication rates and associated costs before and after conference implementation were used to calculate total cost reduction. RESULTS With 3 active spine surgeons and 108 patients per year, the total time investment was 104.04 min per patient, costing $21,791 annually. Total RN equivalent value per patient was 5.25 for all three phases. Using a historical model, this multidisciplinary approach for adult spinal deformity reduced complications by 51% at 30 days, resulting in cost savings of $418,518 per year. Thus, the model demonstrates that implementation of this approach resulted in a potential total savings of $396,726/year. CONCLUSION Implementing a cost-saving tool for managing complex spinal disorders is a responsibility of the spine team, who should lead a multidisciplinary conference. The combination of TDABC and lean methodology can effectively demonstrate the variable costs associated with this multidisciplinary effort and models provide evidence of potential cost-savings when applied to a multidisciplinary adult spinal deformity conference. These findings should encourage clinicians and administrators to allocate resources to improve patient care by reducing complications and costs.
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Affiliation(s)
- Rajiv Sethi
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA.
- Schools of Medicine and Public Health, University of Washington, Seattle, WA, USA.
- Division of Health Economics, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Philip Louie
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Aiyush Bansal
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Michelle Gilbert
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Venu Nemani
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Jean-Christophe Leveque
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Caroline E Drolet
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Brooks Ohlson
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Richard Kronfol
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Joseph Strunk
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Kelly Cornett-Gomes
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Andrew Friedman
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
| | - Devon LeFever
- Department of Neurosurgery, Center for Neuroscience and Spine, Virginia Mason Medical Center, Seattle, WA, USA
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Eryilmaz F, Ahmed F, Rehmani AK, Karimi S, Qazi A, Mustafa S, Zulfiqar A, Nadeem Z, Sultan AA, Farooque U. Scoliosis and Gastroesophageal Reflux Disease in Adults. Cureus 2021; 13:e15359. [PMID: 34239791 PMCID: PMC8245622 DOI: 10.7759/cureus.15359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Degenerative scoliosis most commonly presents with lower back pain. Literature suggests that adults who have degenerative scoliosis are at greater risk of both hiatal hernia and gastroesophageal reflux disease (GERD). The objective of this study was to evaluate scoliosis as being the risk factor of GERD in adults. Materials and methods This prospective study was conducted at Dow University of Health Sciences over a period of two years (May 2018 to April 2020). The investigation included 210 participants with spinal disorders. The mean age was 71.6±9.6 years. The X-rays of the participants’ whole spine were taken in a standing position, in the sagittal and coronal planes. Symptoms of GERD were measured through the quality of life and utility evaluation survey technology (QUEST) score, taking six points as cutoff values. The evaluation was done using radiographs to determine any relationship between spinal disorders and GERD. Negative values were analyzed in a right-sided convex curve while positive values in the left-sided convex curve were viewed in the coronal plane. Degenerative scoliosis was explained as a lumbar/thoracolumbar Cobb angle of more than 10 degrees. Univariate and multivariate logistic regression analyses were done to assess the risk factors related to GERD. Results Out of 210 patients, 146 were found to have degenerative scoliosis at the level of the lumbar and thoracolumbar spine. Fifty-two patients had a right convex curve, and 94 had a left convex curve. Sixty-nine patients had GERD. According to the analysis of the multivariate logistic regression, the Cobb angle was highly related to GERD (p-value <0.05 and odds ratio of 1.031). The participants were grouped according to the Cobb angle of curve at the lumbar spine (less than 30 degrees with a large right-sided convex curve, 30 and more with a small curve, and more than 30+ degrees with a large left-sided convex curve). The study revealed that a large left-sided convex curve was highly related to GERD, with a p-value <0.05 and odds ratio of 10.935. Conclusions The left-sided large convex curve at the thoracolumbar or lumbar spine, especially when the Cobb angle was more than 30 degrees, was highly associated with GERD. Therefore, the symptoms of GERD should be monitored in the elderly population with degenerative scoliosis.
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Affiliation(s)
- Fahri Eryilmaz
- Neurological Surgery, Hitit University Corum Erol Olcok Training and Research Hospital, Corum, TUR
| | - Faheem Ahmed
- Orthopedic Surgery, Trauma Centre, Civil Hospital, Karachi, PAK
| | - Asim K Rehmani
- Neurological Surgery, National Medical Center, Karachi, PAK
| | - Sundas Karimi
- Orthopedic Surgery, Dow University Hospital, Karachi, PAK
| | - Aamna Qazi
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Sufyan Mustafa
- Medicine, Dow Medical College, Civil Hospital, Karachi, PAK
| | - Arif Zulfiqar
- Medicine and Surgery, Dow Medical College, Karachi, PAK
| | - Zubia Nadeem
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ayyaz A Sultan
- Hematology/Oncology, California Cancer Associates for Research and Excellence, Fresno, USA
| | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
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