Impact of Single Position on Patient Outcomes and Cost in Minimally Invasive Adult Spinal Deformity Surgery

Thursday, June 1, 2023

8:30 AM – 6:15 PM

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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Co-Author(s)

PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

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

Peter S. Tretiakov, BS

United States
AS

Andrew J. Schoenfeld, MD, MSc

Associate Professor
Brigham and Women's Hospital, Department of Orthopaedic Surgery
Boston, Massachusetts, United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AM

Angel Macagno

United States

Submitter(s)

PP

Peter G. Passias, M.D.

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

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Disclosure(s):

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

Background: Compared to repositioning patients for pedicle screw placement after lateral interbody fusion, single position spine surgery can improve surgical efficiency, reduce operative times, and reduce operative costs.

Purpose: To assess surgical outcomes and cost of single position thoracolumbar adult spinal deformity surgery.

Methods: Operative minimally invasive ASD patients (coronal Cobb angle≥20°, SVA≥50mm, PT≥25°, and/or thoracic kyphosis>60°) >18yrs with complete baseline (BL) and perioperative radiographic/HRQL data were included. Patients were stratified based on approach: single position (SP) and flipped (FL) groups. Total costs were calculated from average Medicare DRG reimbursement. Complications, comorbidities (CC), major complications, and comorbidities (MCC) were assessed according to CMS.gov manual definitions. Means comparison, multivariable logistic regressions and ANCOVA were utilized to assess differences in outcomes between SP and F groups.

Results: 230 patients met inclusion criteria (60.5yrs, 76%F, BMI: 30.1kg/m2, CCI: 1.8), with 131 patients in the single position (SP) group and 69 patients in the flipped (FL) group. While gender composition and CCI were similar between single position and flipped patients, single position patients were significantly older (63.9±10.9 vs. 56.6±10.2, p<.001) with significantly lower BMI (29.2±5.3 vs. 31.8±6.6, p=.003) and mFI5 scores (0.6±0.9 vs. 1.2±1.0, p<.001). Compared to flipped patients, single position patients had significantly lower operative time (184.6±122.7 vs. 458.0±162.5 min, p<.001)), EBL (176.0±203.9 vs 727.2±832.4 mL, p<.001), and length of stay (2.7 vs. 5.4 days, p<.001). However, after accounting for baseline demographics, osteotomies, and levels fused, only operative time and length of stay remained significantly different between groups (both p<.007). Logistic regression accounting for baseline demographics, levels fused and osteotomies found that single position patients had significantly lower odds of experiencing any complication between 90 days and 2-years (OR: 0.032, 95% CI: .003 - .328, p=.004). Furthermore, accounting for baseline demographics, osteotomies, and levels fused, single position patients had significantly lower odds of undergoing reoperation perioperatively (OR: .045, 95% CI: .004 - .518, p=.013). Finally, accounting for baseline demographics, osteotomies, and levels fused, mean cost was significantly lower for patients in the single position group ($33,806.98 vs $42,549.63, p=.011).

Conclusions: Despite accounting for differences in demographics and surgical details, single position patients had shorter operative times, length of stay, and lower rates of reoperation than patients in the flipped group. Collectively, these differences resulted in significantly lower operative costs for single position surgeries. While further studies are needed to assess long term outcomes, single position thoracolumbar spine surgery could potentially reduce costs associated with operative time, hospital stay, and reoperations.