Comparative Analysis of Cost Utility of Single-Position Prone Lateral versus Lateral Decubitus Positioning in Minimally-Invasive Spine Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
PD

Pooja R. Dave

Miami, Florida, United States
JL

Jordan Lebovic, MD, MBA

Resident
NYU Langone Orthopedics
New York, New York, United States
NP

Nicholas Post

United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States
AM

Angel Macagno

United States
AD

Alexandre Demoura

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

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Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Recent literature has pointed to the rising use of prone lateral versus lateral decubitus positioning in Minimally-Invasive Spine Surgery (MISS) as a method to reduce operative time, increase patient safety, and aid in surgical accessibility. However, there is a paucity of literature as to how prone lateral and lateral decubitus positioning compares in terms of achieving cost-effective outcomes.

Purpose: To assess differences in cost effectiveness and cost utility between prone lateral and single-position lateral decubitus positioning compares in terms of reaching optimal postoperative outcomes and reducing complication rates.

Methods: MISS patients with baseline (BL) and 2-year(2Y) postop radiographic/HRQL data were included. Patients positioned in the single-position Prone Lateral (PL) or single-position Lateral Decubitus (LD) position were isolated. Means comparison analysis assessed differences in radiographic and clinical outcomes at BL, 1Y, and 2Y post-op. Costs were calculated using the PearlDiver database through estimates from Medicare pay-scales for services within a 30-day window, including estimates regarding costs of postoperative complications, outpatient healthcare encounters, revisions and medical related readmissions. Quality-adjusted life years (QALYs) was calculated using NDI mapped to SF6D using validated methodology and utilized a 3% discount rate to account for residual decline to life expectancy (78.7 years).

Results: 66 Prone Lateral and 43 Lateral Decubitus patients were included (54.40±12.49 years, 40% female, 30.93±6.52 kg/m2, mean CCI: 2.23±1.55) were included. At baseline, patients were comparable in age, gender, BMI, and CCI (all p>.05). Peri-operatively, PL patients demonstrated significantly lower operative time (200.09 vs 284.54 min, p=.007) and EBL (332.35 vs 192.05 mL, p=.027). Though optimization scores were equivalent between groups (p=.160), PL patients demonstrated significantly lower peri-operative complication rates (p=.012), neurological complication rates (p=.006), and had a fewer number of total complications by 2Y (p=.014). Economic analysis revealed broad cost savings for PL patients. Specifically, PL patients demonstrated increased utility gained per QALYs at 1Y (p=.028), as well as Life Expectancy QALYs (p=.002). Furthermore, PL patients were significantly more likely to demonstrate increased QALYs gained by 2Y (p=.029). Conversely, overall cost per QALY by 2Y was significantly higher for LD patients, which resulted in an approximately 2.3x greater cost per QALY for such patients (76,848 vs 11,839 USD). Overall, PL patients demonstrated significantly higher cost-effectiveness by 2Y (p <.001).

Conclusions: Patients placed in the Prone Lateral position during minimally-invasive adult spinal deformity surgery demonstrate decreased cost versus patients operated on via single-position Lateral Decubitus positioning. Due to potential benefits in achieving cost-effective outcomes, Prone Lateral approach should be considered as there may be significantly reduced financial burden on patients, surgeons, and institutions due to lower risk of complications and reoperation.