Abstract
Future of Cervical Spinal Fusions in the United States: What does ARIMA Forecasting Indicate about Utilization and Economics by 2040?
Neurosurgery, Vol.67(Supplement_1)
12/01/2020
DOI: 10.1093/neuros/nyaa447_142
Abstract
INTRODUCTION The increment in spinal fusions witnessed in the past two decades associated with rising costs has questioned the future economic viability of these procedures. As healthcare reforms in spine surgery advocate transition to bundled payments, it is pertinent to forecast procedural rates to understand utilization and economics for future planning. METHODS In a time series modeling, ARIMA algorithms forecasted annual rates of CSFs from 2015–2040. For forecasting, HCUP datasets 2001–2014 are used. The primary endpoints are percent-change in the yearly forecast estimates of CSFs up to 2040 based upon surgery type (primary vs. revisions) and approach [C1-C2 fusions, anterior cervical fusion (ACF), and posterior cervical fusion (PCF)]. Additionally, hospital stay (LOS) and economics (costs) are forecast until 2040. All forecasting is compared to the baseline 2014 estimates. RESULTS Primary CSFs utilization will increase by approximately 34% by 2030 and 54% by 2040 from baseline 2014. The revision surgery will outpace primary CSF surgery with an increase of +106% (in 2030) and +172% (in 2040). For primary CSFs, utilization rates of PCFs (2030: +83%; 2040: +136%) will exceed ACFs (2030: +24%; 2040: +39%) or C1-C2 fusions (2030: +60%; 2040: +99%) from their respective baseline rates. [The LOS will decrease by 10% (2030) and 17% (2040) from 3.93 days in 2014. Despite decrease in LOS, hospital costs will increase by 37% (+$11,939 in 2030) and 62% (+$19,650 in 2040). CONCLUSION The study forecasts increased utilization rates of C1-C2 fusions, ACFs, and PCFs in the US by 2040 for both primary and revision CSF surgeries. From a policymaking perspective, the data underscores the need for appropriate resource allocation including the establishment of ACGME-accredited spine fellowships to train the adequate number of future neurosurgery/orthopedic residents to optimize future spine care/access. Ameliorative measures by federal/national organizations in this direction may preclude overwhelming of the healthcare system from increasing demand and ensure the economic viability of spine healthcare delivery.
Details
- Title: Subtitle
- Future of Cervical Spinal Fusions in the United States: What does ARIMA Forecasting Indicate about Utilization and Economics by 2040?
- Creators
- Piyush KalakotiChristian BowersMeic SchmidtDaniel SciubbaAndrew Pugely
- Resource Type
- Abstract
- Publication Details
- Neurosurgery, Vol.67(Supplement_1)
- Publisher
- Oxford University Press
- DOI
- 10.1093/neuros/nyaa447_142
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Date published
- 12/01/2020
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984306134102771
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