Research Fellow NYU Langone Health Paterson, New Jersey, United States
Introduction: As our focus on delivering cost effective healthcare increases, interventions like cervical deformity surgery, which are associated with high resource utilization, have received greater scrutiny.
Methods: Retrospective analysis of a single-center ACD database. ACD Patients ≥18 years with baseline(BL) and 2-year(2Y) HRQL data were included. Cost of surgery was calculated by applying average Medicare reimbursement rates by applicable CPT codes. Costs of complications and reoperations were intentionally excluded from the cost analysis. Patients were ranked into two groups by surgical cost: lowest cost (LC) and highest cost (HC). ANCOVA assessed differences in outcomes while accounting for covariates as appropriate.
Results: 89 patients met inclusion (LC: 43; HC 44). LC and HC groups had similar demographics and baseline cSVA (HC: 43.3mm vs. LC: 49.0mm, p>.05) as well as TS-CL (HC: 36.6° vs. LC: 38.8°, p>.05). Average reimbursement: LC: $29087 vs. HC: $48720, p<.001. MVA controlling for baseline, found HC patients had a lower TS-CL modifiers at 3-months and 2-Y (p=.034). Additionally, C2-C7 amd C2-T3 deformity modifiers (Passias et al.) were significantly lower in HC patients (both p<.05). Finally, MVA found HC patients met MCID in NDI at significantly higher rates (59% vs. 37%, p=.043).
Conclusion : While patient presentation influences surgical planning and costs, this study attempted to control for such variations to assess impact of surgical costs on outcomes. Despite continued scrutiny over healthcare costs, we found that more costly surgical interventions can produce superior radiographic alignment as well as patient reported outcomes for patients with cervical deformity.
