Impact of Increased Component Utilization in Adult Spinal Deformity Surgery: Identifying Differences in Outcomes based on Cost Utility of Individual Surgical Components

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

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
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

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: The complexity of adult spinal deformity (ASD) corrective surgery can carry a significant cost burden. With increasing focus on value-based healthcare, it is necessary to further study whether high cost component utilizers are cost effective and have greatest utility to patient outcomes.

Purpose: To define increased component utilizers of corrective adult spinal deformity surgery and its influence on positive surgical outcomes.

Methods: Operative ASD patients (scoliosis >20, SVA>5cm, PT>25, or TK>60) with up to 2 year data. Components included: Interbody fusion, percutaneous screws, robotic equipment with navigation, PJK prophylaxis, BMP usage, approach (Anterior, Posterior, Combined), MIS techniques (ALIF, TLIF, LLIF), and number of rods used. Cost for each component was gathered by published item rates, then totaled based on surgical technique. Utility data was calculated using ODI converted to SF-6D using published conversion methods. QALYs utilized a 3% discount rate to account for decline to life expectancy (78.7 years). Cohort was ranked into 3 groups by component usage and total cost: Low, Middle, and High. Multivariate logistic regression used to assess the effect of high cost utilizer (HU) compared to low cost utilizer (LU) s on outcomes.

Results: 363 were included (60.5yrs, 76%F, BMI: 28.0kg/m2, CCI: 1.8). Once ranked, 156 patients fell into the H and L groups respectively. Average cost for LU was $53,632 vs. $99,273 in HU, p<.001. Within HU, greatest cost came from robotic equipment ($47,189) and from BMP ($53,023), both p<.05. HU had a higher mean BMI and was more often male (both p<.001). HU had a significantly higher CCI than patients in LU (5.4 vs. 2.3, p=.012). With respect to baseline deformity, the HU was more deformed in SVA (69.6 vs. 52.9mm, p=.003), PI-LL (18.4° vs. 12.3°, p<.001), and PT (25.3° vs. 22.0°, p<.001). MVA controlling for age, CCI, levels fused and osteotomies found patients in the LU had significantly longer length of stay (LU: 8.7, HU: 6.1, p=.010). Compared to patients in the HU, patients in the LU had significantly lower rates of SICU stay (OR: 0.394 [1.01, 1.98], p=.044) and higher baseline frailty scores (6.2 vs. 3.6, p=.034). MVA found HU patients had significantly lower EBL (1566mL vs. 3485mL, p=.017) and lower rates of delayed extubation (29.1% vs. 49.6%, p=.004). MVA found HU were 33% less likely to undergo reoperation (OR: 0.67, [0.487, 0.942], p=.021). Controlling for respective HRQLs, MVA found odds of reaching MCID in SRS-22 Activity (OR: 1.663, [1.273, 2.173], p<.001) and MCID in SRS-22 pain was 1.7x higher for HU (OR: 1.692, [1.231, 2.326], p=.001).

Conclusions: Although patient presentation significantly influences surgical planning and costs, this study sought to assess impact of individual component costs on outcomes and cost. We found that patients in the highest tertile for baseline cost had superior patient reported outcomes compared to those in the lowest tertile. This data suggest that higher cost surgeries can result in better clinical, radiographic, and patient reported outcomes