OBJECTIVES: While technological innovation has advanced the efficacy of spine surgery for patients, these advances do not consistently translate into clinical effectiveness. Defects in health care value, such as the lack of clinical benefit from spine surgery, are common. These defects in value compromise quality and patient experience and can increase costs of care. Our objective is to estimate the cost burden of value defects in spine surgery and predict the savings from eliminating these defects.

METHODS: We systematically reviewed literature of spine surgery-related care that provided low-value (i.e., increased costs for little or negative clinical benefits or patient harm). Rates of spine surgery and negative outcomes were abstracted, as well as the costs of care for these procedures and proceeding opportunity costs negative consequences. Rates of harm combined with costs provided estimates of overall defects in value. The respective cost estimates of quality improvement programs for spine surgery centers of excellence were then applied as cost-offsets to value defects to estimate the net monetary benefit of eliminating value defects. Centers of excellence were defined as facilities specializing in spine surgery delivery using recommended appropriateness criteria.

RESULTS: The authors estimated that combined opportunity costs from all value defects included in this study could exceed $67.6 million in the U.S. every year for the 38,000 patients who undergo spine surgery. These value defects were summed up from the following components: low-volume procedures at low-volume sites of care, $26.4 million; avoidable complications, $2.4 million; avoidable readmissions/ reoperations, $2.0 million; avoidable post-acute care, $36.8 million. Over $28.8 million in value defects could potentially be saved if spine surgery were exclusively provided in centers of excellence.

CONCLUSIONS: Establishing centers of excellence for spine surgery within hospital referral regions may reduce variability in value defects in spine surgery and improve health outcomes in those who stand to benefit most.