1417. Perioperative Risk Scores Correlate with Hospital Costs in Neurosurgical Patients

Authors: Sasha Vaziri, MD; Joseph Abbatematteo; Max Fleisher, BS; Alexander Dru, MD; Dennis Lockney, MD; Paul Kubilis, MS; Daniel Hoh, MD (Gainesville, FL)


The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online Surgical Risk Calculator uses inherent patient characteristics to provide predictive risk scores for adverse postoperative events. The purpose of this study is to determine if predicted perioperative risk scores correlate with actual hospital costs.


A single-center retrospective review of 1,005 neurosurgical patients treated from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted risk scores were compared with actual in-hospital costs obtained from a billing database. Correlational statistics were used to determine if patients with higher risk scores were associated with increased in-hospital costs, additional analysis was performed to determine if increase in-hospital costs were correlated to complication occurrence (as a driver of hospital cost). 


The Pearson correlation coefficient (R) was used to assess correlation between 11 types of predicted complication risk scores and five types of encounter costs from 1,005 health encounters involving neurosurgical procedures. Patients with higher predicted risk scores in all measures except surgical site infection were found to have a statistically significant association with increased actual in-hospital costs (p < 0.0005), interestingly patients predicted risk scores did not correlate to actual occurrence of a complication. 


This study demonstrates that the ACS NSQIP Surgical Risk Calculator's predicted peri-operative risk scores correlate with actual hospital costs. Risk scores have a statistically significant moderate correlation to increased actual in-hospital costs, interestingly patients predicted risk scores did not correlate to actual occurrence of a complication. In our current value-based healthcare environment, the findings from this study compel practitioners to look beyond post-operative complication occurrence as the main driver of hospital cost and consider overall patient frailty and global risk (independent of complication occurrence) in risk-stratification models.