Financial Impact of Perioperative Complications in Adult Spinal Deformity Surgery: Cost Effectiveness Analysis of Outcomes

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
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States
Virginie Lafage, PhD

AVP, Clinical Research
Lenox Hill | Northwell
Hospital for Special Surgery
New York, New York, United States
RL

Renaud Lafage, MS

Senior Biomedical engineer
Lenox Hill Hospital
new york, New York, 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: Adult spinal deformity (ASD) corrective surgery is often a highly invasive procedure with the potential for immediate and long-term complications. However, the perioperative cost impact of each complication has yet to be assessed.

Purpose: to identify cost and cost effectiveness of complications on patient’s perioperative course after ASD corrective surgery

Methods: Operative ASD patients ≥18 years with perioperative data were included. Surgical costs, including cost of complications, were calculated based on 2021 average Medicare reimbursement by CPT code. Complications occurred within 90 days postoperatively and were divided in major and minor groups according to patient response. Complications included: mechanical (rod fracture, rod dislocation, screw breakage, interbody dislocation), medical (cardiopulmonary, gastrointestinal, infection), mechanical combined, revision. Patients were ranked into tertiles by surgical cost for each complication group. The highest cost tertiles were propensity score matched (PSM’d) to account for differences in baseline age and deformity. Multivariable logistic regressions assessed odds of achieving outcomes of interest in groups.

Results: 421 patients met inclusion. (59.9±14.7yrs, 27.3±5.3kg/m2, CCI: 1.63±1.6, FI: 3.12±1.65) were included and underwent surgery (11.5±4 levels fused, EBL: 1565±1406 mL, op time: 371±136 min, LOS: 8.5±4.6 days). After PSM, 237 patients remained in each group with an average reimbursement in Table 1. PSM’d groups had similar demographics and baseline deformity (all p>.05). By 90 days, complication rates: 14% ≥1 complication, 2.1% major, 1% required reoperation. Average cost for index surgery was $30,553.34. Reoperation ($56,352.84), any mechanical complication ($52,325.07), and cardiopulmonary ($47,035) were the highest cost contributors within 90 days of index (all p<.05). Similarly, those with lowest cost utility were Cardiopulmonary ($119,988.32), any mechanical ($129,197.71), and reoperation ($140,181.19), indicating importance of cardiac optimization preoperatively. Complications with the highest cost utility were implant related: Rod Fracture ($21,988.28), Screw Breakage ($29,115.46), further indicating the complexity of complication deters from overall utility. Compared to without complication, odds of MCID in ODI were 48.6% lower across groups (OR: 0.51 [.280, .945], p=.032). Any mechanical complication had worsening MCID achievement in 2 year follow up (69% vs 20%, p=0.06). In particular, rod dislocation negatively impacted rates of BCO (40% vs. 15.2%, p=.029). However mechanical complications in 90 day period were overall lower odds of occurrence compared to medical (OR 2.43 [1.66, 2.13] p=004). Out of medical complications, cardiopulmonary had the lowest odds of BCO (OR: .25, [1.74, 2.18], p<.001), followed by infection (OR: .43, [1.17, 2.98], p<.001).

Conclusions: Mechanical complications had the single greatest impact on cost-utility after adult spinal deformity surgery, but was mitigated by decreased occurrence in immediate perioperative period. Understanding the cost-utility of specific interventions at certain timepoints postoperatively may aid understanding of their economic burden, and prophylactic efforts should strategically be made against early mechanical complications.