Half of the patients had a Charlson Index Score of zero and 11.3 percent had a ?‰?5 score. Charlson Index correlated with length of stay>

Comorbidities had an additive effect on length of stay and hospital cost in the lumbar decompression and fusion patients:

   -The average hospital cost in patients without diabetes mellitus/elevated HbA1c or hypothyroidism: $46,360

   -The average hospital cost in patients with diabetes mellitus/elevated HbA1c or hypothyroidism: $54,228

   -The average hospital cost in patients with both cormorbidities: $61,221

   -The average hospital cost in patients with diabetes mellitus/elevated HbA1c, hypothyroidism and depression: $68,203.

Comorbidities also were tied to an increase in Medicare costs (2008 figures). The cost of DRG 460 and 459 Spinal Fusion was analyzed. In patients with no comorbidities, compensation was $17,131.42. In patients with major complication or comorbidity, compensation was $23,915.70.

"It is important that strategies are devised which include appropriate preoperative screening to help contain comorbidity-related hospital costs. With a large number of older patients undergoing spine surgery every year and the government struggling to contain Medicare costs, the presence of comorbidities is an issue that needs to be taken into consideration prior to surgery," remarked Dr. Walid.

"Further, compensation to physicians must take into account the presence of comorbidities, so that reimbursement amounts are not arbitrarily established," concluded Dr. Robinson.

SOURCE American Association of Neurological Surgeons