P148. Determinants of cost ineffectiveness in adult spinal deformity surgery

• Published in: The spine journal Vol. 21; no. 9; pp. S213 - S214
• Main Authors: Kummer, Nicholas, Krol, Oscar, Passfall, Lara, Ahmad, Waleed, Naessig, Sara, Pierce, Katherine E., Patel, Karan S., Vira, Shaleen N., Kapadia, Bhaveen H., Diebo, Bassel G., Janjua, Muhammad B., Schoenfeld, Andrew J., O'Connell, Brooke K., Maglaras, Constance, Paulino, Carl B., Sciubba, Daniel M., De la Garza Ramos, Rafael, Lafage, Renaud, Buckland, Aaron J., Protopsaltis, Themistocles S., Lafage, Virginie, Passias, Peter G., Fernandez, Laviel, Ihejirika-Lomedico, Rivka C.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.356

Adult spinal deformity correction has been demonstrated to result in improved pain and function. However, the financial implications of these procedures on health care systems can be profound, particularly when subject to complications/failures. Evaluate pre- and postoperative patient and surgical metrics, and to elucidate their relationship to total health care costs. Retrospective. A total of 183 Adult Spinal Deformity (ASD) patients. Utility Gained, Oswestry Disability Index (ODI), Cost, Quality Adjusted Life Year (QALY), Cost Effectiveness (Cost/QALY). The cohort was isolated to those who had baseline and 2-year Health Related Quality of Life (HRQL) data. Total cost was derived from PearlDiver, which accounts for costs within 30 days (including length of stay and mortality) differentiated by surgical approach, complications, and reoperation. Cost per Quality Adjusted Life Year (QALY), was calculated via published methods from ODI. Patients who did not have a positive utility gained indicated cost ineffectiveness. This cohort of patients (utility lost, UL) was compared to those who were cost effective (utility gained, UG) by means comparison analyses (chi-squared ANOVA) to determine the differentiating factors between cost ineffectiveness and effectiveness. Conditional Inference Tree analysis (CIT) ranked associated factors. There were 183 patients, 53 (29.0%) UL and 140 (20.6%) UG. Patients in these groups differed in baseline radiographic and HRQL measurements as well as complication rates:Pelvic Tilt: UL=17.68; UG=24.25; p=0.001PI-LL: UL=3.52; UG=12.97; p=0.013L1-S1: UL=50.39; UG=41.06; p=0.021TPA: UL=14.91; UG=22.29; p=0.002SVA: UL=25.06; UG=53.01; p=0.011Any Complication: UL=32.1%; UG=48.5%; p=0.043Major Complication: UL=5.66%; UG=23.1%; p=0.005BL ODI: UL=18.96; UG=34.47; p<0.001Y2 ODI: UL=28.61; UG=16.88; p<0.001After CIT, the factors most associated with UL in descending order: BL pelvic tilt, BL T1 PA, Age, CCI, BL L1S1, operative time, number of major and minor complications, BL T2-T12 thoracic kyphosis, BL TS-CL, BL Frailty, BL cSVA. Factors that were most influential in a high overall cost in decreasing order by CIT: number of complications, number of reoperations, number of major and minor complications, BL cSVA, osteotomy, frailty, body mass index, LOS. Patients that had Utility Lost had better HRQL scores and less severe radiographic measures at baseline compared to patients that were Utility Gained. This possibly indicates that instance of complications, despite being lower than those of Utility Gained, outweighed the benefits of surgery for Utility Lost patients who had less severe radiographic measures. This abstract does not discuss or include any applicable devices or drugs.