OBJECTIVES

: Neuromonitoring technology is an innovation that assists spinal surgeons in detection of compromised nerves during spinal surgery. Common types used during spinal surgery include electromyography (EMG), somatosensory evoked potential (SEP), motor evoked potential (MEP); these modalities can be used alone or concurrently. To understand the associated costs with these therapies, this study characterizes hospital costs of surgeries with neuromonitoring.

METHODS

: Patients who underwent primary posterior or anterior lumbar fusions with neuromonitoring from 2015 to 2017 were selected using ICD-10 and CPT-4 codes from the Premier Healthcare Database. Patients who received EMG, MEP, SEP or patients with less utilized neuromonitoring (Other) were identified; patients with >1 therapy were grouped as Combination. Patient demographic and clinical characteristics, hospital costs, total and itemized, for the index surgery were estimated. All costs are reported in U.S. dollars and adjusted for 2016 inflation.

RESULTS

: A total of 4,088 (10%) of patients had neuromonitoring among the 42,929 patients identified. The proportion of modalities were EMG 0.5%, MEP <0.1%, SEP 2.2%, Other <0.1%, and Combination 6.7%. Mean age (standard deviation (SD)) of patients who had neuromonitoring was similar across groups (range 60 (15.6) to 61.7 (12.5)). There was a similar trend in Elixhauser comorbidity score: most patients per group had 1-2 comorbidities; range of proportion: 50% to 67%. Mean total hospital costs of surgery with EMG ($32,997 ($15,397)) and Other ($32,101 ($13,182)) were lower versus SEP ($39,056 ($17,690)), MEP ($57,762 ($14,087)), or Combination ($36,521 ($21,838)). Mean operation room costs followed a similar trend: EMG and Other had lower costs, ($5,903 ($3,435)) and ($ 5,528 ($2,231)), respectively, versus SEP ($10,143 ($4,786), MEP ($6,280 ($1,002), Combination ($7,029 ($4,453)).

CONCLUSIONS

: Hospital costs for patients who have neuromonitoring at the time of lumbar fusion procedures vary by type of modality. Evaluation of these costs helps to contextualize healthcare expenses for lumbar fusions with neuromonitoring.