Introduction: Nearly one million Americans undergo spine surgery annually, with inpatient costs ranging from $4,500 to $30,000 per procedure. Health insurers may require pre-operative PT to manage costs and encourage conservative treatment, though this may delay surgery without reducing utilization or costs. This study assesses healthcare utilization and costs in patients receiving versus not receiving PT before cervical fusion surgery.
Methods: A retrospective analysis of administrative claims data from 2007-2021 was conducted with the Merative Marketscan Commercial Claims and Encounters Database. Patients aged 18+ undergoing cervical fusion with or without decompression were included. The index date was based on the earliest neurological diagnosis for pain, decreased function, or numbness. The exposure was receipt of PT between the index date and surgery. Outcomes included surgical length of stay (LOS), 90-day emergency/inpatient readmissions, prescribed morphine milligram equivalents (MMEs) within one year post-surgery, hospitalization expenditure, and total inpatient/outpatient costs within one year post-discharge. Propensity score matching (1:1 nearest neighbor without replacement) was used based on age, sex, year of operation, geographic region, Elixhauser comorbidities, and insurance plan.
Results: Of 122,005 patients, 71,428 (58.5%) did not receive pre-operative PT, and 50,577 (41.5%) did. Propensity score matching resulted in 46,784 matched pairs. Pre-operative PT was associated with shorter LOS (mean [SD], 1.84 [2.55] vs. 2.08 [3.08] days; P < 0.001), decreased 90-day readmission rate (0.20 [0.40] vs. 0.21 [0.41]; P < 0.001), reduced hospitalization expenditure ($40,684.30 [$37,244.29] vs. $42,288.81 [$40,335.51]; P < 0.001), and decreased total one-year costs ($60,754.80 [$68,865.81] vs. $61,752.96 [$70,365.51]; P < 0.05). No difference was found in prescribed MMEs within one year post-surgery (4,046.02 [8,781.22] vs. 3,971.56 [8,772.41]; P > 0.05).
Conclusion : Pre-operative PT was associated with reduced healthcare utilization and costs for cervical fusion surgery. Insurers may consider increasing uptake of PT for such patients.
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