Increasing Cost Efficiency in Adult Spinal Deformity Surgery: Identifying Predictors of Lower Total Costs.
Spine (Phila Pa 1976)
; 47(1): 21-26, 2022 Jan 01.
Article
en En
| MEDLINE
| ID: mdl-34392276
ABSTRACT
STUDY DESIGN:
Retrospective study of a prospective multicenter database.OBJECTIVE:
The purpose of this study was to identify predictors of lower total surgery costs at 3âyears for adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA ASD surgery involves complex deformity correction.METHODS:
Inclusion criteria surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5âcm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18âyears. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.RESULTS:
Three hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3âyears was found to be $72,947.87, with no significant difference in costs between deformity groups (Pâ>â0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores <0.19, baseline (BL) SRS Activity >1.5, BL Oswestry Disability Index <50 (all Pâ<â0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores >1.5, age <64, were the top predictors of lower costs (all Pâ<â0.05). Among MSVA patients, ASD invasiveness scores <94.16, no past history of cancer, and frailty scores <0.3 trended toward lower total costs (Pâ=â0.071, Pâ=â0.210). For HSVA, no history of smoking and body mass index <27.8 trended toward lower costs (both Pâ=â0.060).CONCLUSION:
ASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence 3.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Escoliosis
/
Cifosis
Tipo de estudio:
Health_economic_evaluation
/
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
/
Humans
Idioma:
En
Revista:
Spine (Phila Pa 1976)
Año:
2022
Tipo del documento:
Article