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P85. Detailed risk factor stratification in adult spinal deformity corrective surgery: a 3-year cost utility analysis.

Authors :
Williamson, Tyler
Lebovic, Jordan
Passias, Peter G.
Imbo, Bailey
Tretiakov, Peter
Joujon-Roche, Rachel
Krol, Oscar
Varghese, Jeffrey J.
Dhillon, Ekamjeet Singh
Diebo, Bassel G.
Vira, Shaleen N.
Lafage, Renaud
Janjua, Muhammad Burhan
Passfall, Lara
Moattari, Kevin
Smith, Justin S.
Koller, Heiko
Schoenfeld, Andrew J.
Owusu-Sarpong, Stephane
Lafage, Virginie
Source :
Spine Journal. 2022 Supplement, Vol. 22 Issue 9, pS167-S167. 1p.
Publication Year :
2022

Abstract

A previous study by Pellisé et al identified strong preoperative and surgical predictors of major complications. It is unknown which of these risk factors has the most significant impact on cost-effectiveness. To assess the impact of previously established risk factors on the cost effectiveness of ASD surgery. Retrospective. A total of 689 ASD patients. Quality adjusted life years (QALYs), utility gained, ODI, total cost. ASD patients with baseline (BL) and 2-year postoperative (2Y) data were included. Frailty score, sagittal deformity measures (SVA, PI-LL, T1 Sagittal Tilt), blood loss and surgical time were divided into tertiles, with the highest tertile being classified as high risk. Since some patients have multiple risk factors, they may be included in multiple groups. Descriptive analysis identified demographics, radiographic parameters and surgical factors. Published methods for cost was calculated using the PearlDiver database and CMS.gov definitions. Cost per QALY at 2Y was calculated for each risk factor. There were 422 patients included. Of the 381 patients with a risk factor, 77% were fused to the pelvis, 44% were highly frail, 56% had a high deformity, 34% had high EBL and 34% had high operative time. When analyzing BL scores, highly frail patients had the highest mean ODI and EQ-5D. After undergoing surgery, patients with a high EBL had the highest rate of SICU admissions, rate of any complications and rate of major complications. This translated to patients with high EBL having the lowest utility gained at 2Y. Interestingly, patients with high frailty had the highest rates of implant complications and pseudarthrosis resulting in the second highest major complication rates and total estimated cost. Despite this high estimated cost, however, patients with high frailty also achieved the highest utility gained at 2Y resulting in the best cost-utility at two years. Despite having higher rates of implant failures, pseudarthrosis, and major complications, highly frail patients managed to generate the highest utility gained and best cost-effectiveness, while higher blood loss had higher rates of complications as well, but demonstrated the lowest utility gained and cost-utility. Therefore, spine surgeons should limit intraoperative risk factors, such as blood loss and operative time, which would minimize postoperative complications and improve overall cost-effectiveness during correction of adult spinal deformity. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
15299430
Volume :
22
Issue :
9
Database :
Academic Search Index
Journal :
Spine Journal
Publication Type :
Academic Journal
Accession number :
158609072
Full Text :
https://doi.org/10.1016/j.spinee.2022.06.342