Investigation of hospitalization costs for spinal corrective surgery in adult spinal deformity: A multicenter prospective study in Japan.

Abstract

The number of adult spinal deformity (ASD) surgery has increased in recent years; however, it remains associated with significant hospitalization cost. The purpose of this study is to evaluate the total hospitalization cost associated with ASD surgery in Japan and to identify cost-related factors. This multicenter prospective observational study included patients aged 50-79 years who underwent corrective fusion of more than 5 vertebral segments between March 2021 and March 2024. Demographic, surgical, and radiographic data were collected. Total hospitalization cost, including surgical procedure, surgical supplies, implants, anesthesia, transfusion, rehabilitation, and bundled hospitalization cost were obtained from medical billing data. Univariate and multivariate analyses were performed to determine factors independently associated with total cost. A total of 194 patients (25 males, 169 females; mean age 69.4 ± 6.7 years) were included. The average total hospitalization cost was $47,923.8 ± 8631.1, with implant cost accounting for the largest proportion. Multivariate linear regression analysis identified staged surgery as the most significant independent predictor of increased total cost, followed by the number of fused vertebrae, surgical time, and the use of lateral lumbar interbody fusion (LLIF). Staged surgery was associated with longer surgical time, more fused vertebrae, and more frequent use of LLIF, resulting in approximately 10,000 USD higher total cost than single surgery. This multicenter prospective study revealed that the total hospitalization cost for ASD surgery exceeded USD 47,000 per patient. Staged surgery was identified as the most significant independent factor associated with increased costs, primarily due to higher surgical procedure and implant-related cost.