P64. Monthly multidisciplinary adult spinal deformity conference is highly cost-effective: cost-analysis utilizing lean methodology and time-driven activity-based costing

BACKGROUND CONTEXT Cost-effective pathways in health care are vital in this current health care system. Applying lean methodology with accurate cost accounting provides further descriptions of value for specific interventions. In this study, we apply time driven activity-based costing (TDABC) to assess the cost-effectiveness of a multidisciplinary adult spinal deformity conference that was designed based on value streams under lean methodology. PURPOSE To understand costs and provide an initial framework associated with conference implementation as it pertains to complication prevention. STUDY DESIGN/SETTING Single institution prospective cohort. PATIENT SAMPLE Consecutive patients indicated for adult spinal deformity reconstruction of greater than 6 levels performed by 1 of 3 fellowship-trained spine surgeons, were prospectively recorded from August 2022 to December 2022. Inclusion criteria required that the episode of care followed the institution's complex spine fusion lean methodology-based value stream, which includes presentation at monthly complex spine conferences attended by a multidisciplinary treatment team (anesthesia, pain management, neuropsychology, medicine, physiatry, neurosurgery, and orthopedic surgery). OUTCOME MEASURES Total cost of conference stakeholders' time was calculated based on TDABC parameters. Complication prevention rates were determined from a published study from this institution using patients undergoing a similar process. Complication costs were obtained from literature. METHODS Total time spent by each team member on conference preparation, presentation, and follow-up tasks was recorded for each conference. Data was aggregated to determine the average amount of time required to prepare and present one patient. Using a 2022 mean hourly rate based on our urban hospital setting, a wage value was calculated for each personnel type, and applied to the minutes spent by that personnel type. Total cost of the conference was annualized and then calculated from the time spent in the three phases of the conference multiplied by the wage rate. Published data regarding complication rates before and after conference implementation as well as costs associated with different complications were used to calculate total cost reduction. RESULTS Implementation of a multidisciplinary approach to adult spinal deformity resulted in a 51% decrease in all complications at 30 days (RR 0.49 [95% CI 0.30-0.78]). Total cost savings from complication reduction was $418,518 annually. With 3 active adult spine surgeons there were 108 patients presented per year. Total time investment was 237.06 minutes/patient (total annual cost $16,411). Implementation of this conference resulted in a savings of $402,107/year. CONCLUSIONS The decision to implement a cost-saving tool in the management of patients with complex spinal disorders lies heavily on the shoulders of the spine team to lead a multidisciplinary conference. This combination of TDABC and lean methodology showed significant cost-savings associated with implementation of a multidisciplinary adult spinal deformity conference. These findings should be used to further encourage clinicians and administrators to allocate appropriate resources to improve the safety and value of their patient care through the reduction of complications and costs. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Cost-effective pathways in health care are vital in this current health care system. Applying lean methodology with accurate cost accounting provides further descriptions of value for specific interventions. In this study, we apply time driven activity-based costing (TDABC) to assess the cost-effectiveness of a multidisciplinary adult spinal deformity conference that was designed based on value streams under lean methodology. To understand costs and provide an initial framework associated with conference implementation as it pertains to complication prevention. Single institution prospective cohort. Consecutive patients indicated for adult spinal deformity reconstruction of greater than 6 levels performed by 1 of 3 fellowship-trained spine surgeons, were prospectively recorded from August 2022 to December 2022. Inclusion criteria required that the episode of care followed the institution's complex spine fusion lean methodology-based value stream, which includes presentation at monthly complex spine conferences attended by a multidisciplinary treatment team (anesthesia, pain management, neuropsychology, medicine, physiatry, neurosurgery, and orthopedic surgery). Total cost of conference stakeholders' time was calculated based on TDABC parameters. Complication prevention rates were determined from a published study from this institution using patients undergoing a similar process. Complication costs were obtained from literature. Total time spent by each team member on conference preparation, presentation, and follow-up tasks was recorded for each conference. Data was aggregated to determine the average amount of time required to prepare and present one patient. Using a 2022 mean hourly rate based on our urban hospital setting, a wage value was calculated for each personnel type, and applied to the minutes spent by that personnel type. Total cost of the conference was annualized and then calculated from the time spent in the three phases of the conference multiplied by the wage rate. Published data regarding complication rates before and after conference implementation as well as costs associated with different complications were used to calculate total cost reduction. Implementation of a multidisciplinary approach to adult spinal deformity resulted in a 51% decrease in all complications at 30 days (RR 0.49 [95% CI 0.30-0.78]). Total cost savings from complication reduction was $418,518 annually. With 3 active adult spine surgeons there were 108 patients presented per year. Total time investment was 237.06 minutes/patient (total annual cost $16,411). Implementation of this conference resulted in a savings of $402,107/year. The decision to implement a cost-saving tool in the management of patients with complex spinal disorders lies heavily on the shoulders of the spine team to lead a multidisciplinary conference. This combination of TDABC and lean methodology showed significant cost-savings associated with implementation of a multidisciplinary adult spinal deformity conference. These findings should be used to further encourage clinicians and administrators to allocate appropriate resources to improve the safety and value of their patient care through the reduction of complications and costs.