The impact of surgical material on hospital cost: Economic analysis of allograft vs. autograft for elective one- and two-level anterior cervical decompression and fusion surgery

Abstract

Background Context: Studies demonstrate comparable clinical results with the use of either autogenous hip bone (autograft) or cadaver bone (allograft) for both single and multilevel anterior cervical decompression and fusion (ACDF) with rigid plate fixation. Purpose: Very few studies, however, have analyzed the economic implications of these two ACDF variations. We analyze the short-term hospital economic impact of these alternatives. Study Design and Setting: A retrospective study in a tertiary care center in central Georgia. Patient Sample: 550 consecutive elective 1- or 2-level ACDF patients met inclusion criteria for our study. 305 consecutive patients undergoing 1-level ACDF with rigid plate fixation (mean age 50.5 years) and 245 consecutive 2-level patients (mean age 52.6 years) received allograft implants (1-level n=86, 2-level n=33) or autograft (1 level n=219, 2-level n=212) bone. 32 patients were treated in an outpatient setting. Outcome Measures: Hospital charges were reviewed for cost factors such as procedure time, hospital supplies, labor, and length of stay. Methods: T-tests were used to establish statistical significance of any differences between the studied variables with respect to the choice of allograft vs. autograft. Results: Allograft usage led to statistically insignificant faster average procedure times for both 1-level (80.9 vs. 83.3 min, p>0.05) and 2-level patients (97.6 vs. 99.8 min, p>0.05). Allograft resulted in significant reductions in average length of stay (LOS) for 1-level patients (0.78 vs. 1.37 days, p<0.01), but insignificant reductions in average LOS for 2-level patients (1.21 vs. 1.42 days, p>0.05). For hospital charges, allograft usage resulted in insignificantly higher mean hospital charges for 1-level patients (allograft $17,243, autograft $16,969, p>0.05), but significantly increased hospital charges for 2-level patients (allograft $21,240, autograft $19,056, p<0.01). Significant variances in cost included allograft implants in allograft procedures 1 s and pain pumps in autograft procedures. Conclusion: In 1-level patients undergoing ACDF, allograft usage yielded a shorter length of hospital stay with comparable hospital charges as autograft. However, for 2-level patients undergoing ACDF, allograft yielded higher hospital charges at a statistically significant rate, without yielding statistically significant reductions in LOS. As with many issues, the decision as to which graft type to use for ACDF procedures is a multi-factorial issue. Both short and long term cost considerations must be heavily weighed. The limitations of our study must also be weighed against our conclusions. © 2012 Nova Science Publishers, Inc. All rights reserved.