Immediate Reconstruction of Oncologic Spinal Wounds Is Cost-Effective Compared with Conventional Primary Wound Closure.

BACKGROUND: Several studies have demonstrated a reduced wound complication rate when immediate soft-tissue reconstruction is performed after complex spine instrumentations in high-risk patients; however, the cost-effectiveness of this technique is not known. The authors hypothesized that immediate soft-tissue reconstruction of oncologic spine wounds would be a cost-effective strategy compared with the standard of care (i.e., oncologic spine surgery with conventional primary wound closure). METHODS: The authors used a decision tree model to evaluate the cost-utility, from the perspective of a hospital/insurer, of immediate reconstruction relative to the standard of care after oncologic spine surgery. A systematic review of the literature on oncologic spine surgery and immediate and delayed spinal wound reconstruction was performed to estimate health state probabilities. Overall expected cost and quality-adjusted life-years were assessed using a Monte Carlo simulation and sensitivity analyses. RESULTS: Immediate soft-tissue reconstruction after oncologic spine surgery had an expected cost of $81,458.90 and an expected average of 24.19 quality-adjusted life-years, whereas primary wound closure (no reconstruction) had an expected cost of $83,434.34 and an expected average of 24.17 quality-adjusted life-years, making immediate reconstruction the dominant, most cost-effective strategy. Monte Carlo sensitivity analysis demonstrated that immediate reconstruction was the preferred and most cost-effective option in the majority of simulations. Even when the willingness-to-pay threshold varied from $0 to $100,000 per quality-adjusted life-year, immediate reconstruction remained the dominant strategy across all iterations. CONCLUSION: This cost-utility analysis suggests that immediate soft-tissue reconstruction after oncologic spine surgery is more cost-effective than primary closure alone.

An evaluation of information on the internet about a new device: the cervical artificial disc replacement.

STUDY DESIGN: Cross-sectional survey. OBJECTIVE: The objective of this study was to investigate the authorship, content, and quality of information available to the public on the Internet pertaining to the cervical artificial disc replacement device. SUMMARY OF BACKGROUND DATA: The Internet is widely used by patients as an educational tool for health care information. In addition, the Internet is used as a medium for direct-to-consumer marketing. Increasing interest in cervical artificial disc replacement has led to the emergence of numerous Web sites offering information about this procedure. It is thought that patients can be influenced by information found on the Internet. METHODS: A cross section of Web sites accessible to the general public was surveyed. Three commonly used search engines were used to locate 150 (50/search engine) Web sites providing information about the cervical artificial disc replacement. Each Web site was evaluated with regard to authorship and content. RESULTS: Fifty-three percent of the Web sites reviewed were authorized by a private physician group, 4% by an academic physician group, 13% by industry, 16% were news reports, and 14% were not otherwise categorized. Sixty-five percent of Web sites offered a mechanism for direct contact and 19% provided clear patient eligibility criteria. Benefits were expressed in 80% of Web sites, whereas associated risks were described in 35% or less. European experiences were noted in 17% of Web sites, whereas only 9% of Web sites detailed the current US experience. CONCLUSION.: The results of this study demonstrate that much of the content of the Internet-derived information pertaining to the cervical artificial disc replacement is for marketing purposes and may not represent unbiased information. Until we can confirm the content on a Web site to be accurate, patients should be cautioned when using the Internet as a source for health care information related to cervical disc replacement.

Effect of young age on prostate cancer survival: a population-based assessment (United States).

OBJECTIVE: To assess whether men diagnosed with prostate cancer at younger ages have a poorer prognosis. The influence of select factors (race, marital status, stage, histological grade, histology, presence of comorbid cancer, and time of diagnosis) on the relation between age at diagnosis and survival was considered. METHODS: Analyses were based on 289,809 men diagnosed with malignant prostate cancer, ages 40 years and older in the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 1997, actively followed for vital status through 31 December 1998. Cases diagnosed through autopsy or death certificate were excluded. Five-year relative survival and Cox proportional hazards were used for assessment. RESULTS: Five-year relative survival increased, leveled off, and then decreased over the age span. This pattern was most pronounced in men with advanced stage and poor grade tumors. Conditional death hazards that showed significantly higher hazard ratios in younger age groups (i.e. 40-44 and 45-49) represented local/regional stage and poorly differentiated/undifferentiated tumors, distant stage and moderately differentiated, poorly differentiated/ undifferentiated, or unknown grade, and unknown stage and unknown grade. The influence of young age on prostate cancer prognosis for advanced stage and poorly differentiated/undifferentiated cases was not significantly influenced by year of diagnosis or race. CONCLUSIONS: Younger age is a prognostic factor for prostate cancer survival. The relationship between young age at diagnosis and survival is significantly influenced by stage and histological grade at diagnosis.