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Sun H, Kalakoti P, Sharma K, Thakur JD, Dossani RH, Patra DP, Phan K, Akbarian-Tefaghi H, Farokhi F, Notarianni C, Guthikonda B, Nanda A. Proposing a validated clinical app predicting hospitalization cost for extracranial-intracranial bypass surgery. PLoS One 2017; 12:e0186758. [PMID: 29077743 PMCID: PMC5659612 DOI: 10.1371/journal.pone.0186758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/06/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECT United States healthcare reforms are focused on curtailing rising expenditures. In neurosurgical domain, limited or no data exists identifying potential modifiable targets associated with high-hospitalization cost for cerebrovascular procedures such as extracranial-intracranial (ECIC) bypass. Our study objective was to develop a predictive model of initial cost for patients undergoing bypass surgery. METHODS In an observational cohort study, we analyzed patients registered in the Nationwide Inpatient Sample (2002-2011) that underwent ECIC bypass. Split-sample 1:1 randomization of the study cohort was performed. Hospital cost data was modelled using ordinary least square to identity potential drivers impacting initial hospitalization cost. Subsequently, a validated clinical app for estimated hospitalization cost is proposed (https://www.neurosurgerycost.com/calc/ec-ic-by-pass). RESULTS Overall, 1533 patients [mean age: 45.18 ± 19.51 years; 58% female] underwent ECIC bypass for moyamoya disease [45.1%], cerebro-occlusive disease (COD) [23% without infarction; 12% with infarction], unruptured [12%] and ruptured [4%] aneurysms. Median hospitalization cost was $37,525 (IQR: $16,225-$58,825). Common drivers impacting cost include Asian race, private payer, elective admission, hyponatremia, neurological and respiratory complications, acute renal failure, bypass for moyamoya disease, COD without infarction, medium and high volume centers, hospitals located in Midwest, Northeast, and West region, total number of diagnosis and procedures, days to bypass and post-procedural LOS. Our model was validated in an independent cohort and using 1000-bootstrapped replacement samples. CONCLUSIONS Identified drivers of hospital cost after ECIC bypass could potentially be used as an adjunct for creation of data driven policies, impact reimbursement criteria, aid in-hospital auditing, and in the cost containment debate.
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Affiliation(s)
- Hai Sun
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Piyush Kalakoti
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Kanika Sharma
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Jai Deep Thakur
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Rimal H Dossani
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Devi Prasad Patra
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Barker St Randwick, Prince of Wales Private Hospital, Sydney, Australia
| | - Hesam Akbarian-Tefaghi
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Frank Farokhi
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Christina Notarianni
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Bharat Guthikonda
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
| | - Anil Nanda
- Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, United States of America
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