Demographics
A total of 2041 patients were included. Of those patients 69% (N=1214) had cranial, 16.9% (N=297) had mobile spine, and 14% (N=246) had sacrococcygeal chordoma and chondrosarcoma [Fig.1]. The mean age was 57.4, 49.5, and 47.9 years for the cranial, mobile spine, and sacrococcygeal groups, respectively (P <.001). Females represented 43%, 48%, and 44% of the cranial, mobile spine, and sacrococcygeal groups, respectively. Of the cranial group, 60%, 12%, and 28% had commercial, Medicaid, and Medicare insurance, respectively. Of the mobile spine group, 68%, 14%, and 17% had commercial, Medicaid, and Medicare insurance, respectively. Of the sacrococcygeal group, 73%, 12%, and 14% had commercial, Medicaid, and Medicare insurance, respectively. See [Tables 1 and 2] for additional details.
Index hospitalization and 30 days post discharge outcomes
Index hospitalization, the median length of stay (days) was 4, 6, and 7 for groups 1, 2, and 3 respectively (P<.001). The mean payments were ($58,130), ($84,854), and ($82,440), for groups 1, 2, and 3 respectively (P=.02). The complication rates were 30%, 35%, and 43% for groups 1, 2, and 3 respectively (P<.001).
Thirty days post discharge, the emergency department admissions were 10%, 12%, and 18% for groups 1, 2, and 3, respectively (P=.001). The hospital readmissions were 10%, 23%, and 30% for groups 1, 2, and 3, respectively (p <.001). The complication rates were 18%, 24%, 30% for groups 1, 2, and 3, respectively (P <.001) [Table 3].
Three- and twelve-months post discharge outcomes
Three months post-discharge, the hospital readmission rates were 21%, 38%, and 45% for groups 1, 2, and 3, respectively (P <.001). There was no difference in the number of outpatient services and medications refill among the groups. The overall median payments for this period were ($27,590), ($25,968), and ($35,819), for groups 1, 2, and 3, respectively (P=.04) [Table 3].
Twelve months post-discharge, the hospital readmission rates were 44%, 53%, and 65% for groups 1, 2, and 3, respectively (P<.001). The median number of outpatient services rendered was 166, 165, and 211, for groups 1, 2, and 3, respectively (P <.001). The overall median payments for this period were ($72,294), ($76,827), and ($101,474), for groups 1, 2, and 3, respectively (P <.001) [Table 3], [Fig2.]. The bundled payment for the index hospitalization and 90 days post discharge see [Table 4], [Fig.3].
Adjusted comparison among groups
Using the cranial group (1) as a reference, the index hospitalization of the combined spinal group (groups 2, and 3) had increased length of stay (RR1.2, 1.6, P < .001), a higher complications rate (RR 1.1, 1.8, P<.001), and decreased rate of discharge to home (0RR0.3, 0.25, P<.001). Thirty days post-discharge, the combined spinal group (groups 2 and 3) had a higher ED admission (OR 1.08, 1.7, P=.01), hospital readmission (OR 2.3, 3.1, P <.001), and complications rate (OR 1.5, 2.4, P <.001). Three months post-discharge, the combined spinal group (groups 2, and 3) had a higher hospital admission (OR 2, 2.6, P <.001), and a decreased use of outpatient services (RR 0.8, 0.9, P <.001). The twelve months post-discharge, the combined spinal group (groups 2, and 3) had a higher hospital readmission (OR 1.2, 2.1, P <.001), higher medication refill (RR 1.03, 1.1, P <.001), and a had higher overall payment (RR 1.02, 1.2, P=.02).
Ninety days multivariate analysis
Increased age by 10 years increment was associated with a decreased payment for groups 1, 2, and 3, (OR 0.9, 0.89, and 0.88). Medicaid insurance was associated with a decreased payment for groups 1, 2, and 3 (OR 0.5, 0.3, and 0.47) in comparison to commercial insurance. Medicare was associated with a decreased payment only for group 1 (OR 0.77). EI of 2 was associated with a higher payment for groups 1 and 2 (OR 1.1 and 1.5), while EI of 3 was associated with a higher payment for groups 1, 2, and 3 (OR 1.4, 1.5, 1.4) [Table 5].