{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T04:23:45Z","timestamp":1775708625440,"version":"3.50.1"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:p>The objective was to evaluate medical comorbidities and surgical variables as independent risk factors for increased health care costs in Medicare patients undergoing lumbar fusion. Care episodes limited to lumbar fusions were retrospectively reviewed on the Centers of Medicare and Medicaid Innovation (CMMI) Bundled Payment for Care Improvement (BPCI) reimbursement database at a single academic institution. Total episode of care cost was also collected. A multivariable linear regression model was developed to identify independent risk factors for increased total episode of care cost, and logistic models for surgical complications and readmission. A total of 500 Medicare patients were included. Risk factors associated with increased total episode of care cost included transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) (\u03b2 = $5,399, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) and ALIF+PLF (AP) fusions (\u03b2 = $24,488, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), levels fused (\u03b2 = $3,989, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), congestive heart failure (\u03b2 = $6,161, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.022), hypertension with end-organ damage (\u03b2 = $10,138, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), liver disease (\u03b2 = $16,682, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001), inpatient complications (\u03b2 = $4,548, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.001), 90-day complications (\u03b2 = $10,012, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.001), and 90-day readmissions (\u03b2 = $15,677, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). The most common surgical complication was postoperative anemia, which was associated with significantly increased costs (\u03b2 = $18,478, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Female sex (OR = 2.27, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.001), AP fusion (OR = 2.59, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.002), levels fused (OR = 1.45, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.005), cerebrovascular disease (OR = 4.19, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.003), cardiac arrhythmias (OR = 2.32, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.002), and fluid electrolyte disorders (OR = 4.24, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.002) were independent predictors of surgical complications. Body mass index (OR = 1.07, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.029) and AP fusions (OR = 2.87, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.049) were independent predictors of surgical readmission. Among medical comorbidities, congestive heart failure, hypertension with end-organ damage, and liver disease were independently associated with a significant increase in total episode of care cost. Interbody devices were associated with increased admission cost.<\/jats:p>","DOI":"10.1097\/jmq.0000000000000088","type":"journal-article","created":{"date-parts":[[2022,10,31]],"date-time":"2022-10-31T10:03:39Z","timestamp":1667210619000},"page":"519-527","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Demographics and Medical Comorbidities as Risk Factors for Increased Episode of Care Costs Following Lumbar Fusion in Medicare Patients"],"prefix":"10.1097","volume":"37","author":[{"given":"Mark J.","family":"Lambrechts","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Siegel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson 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