TY - JOUR
T1 - An Economic Analysis of Early and Late Complications After Adult Spinal Deformity Correction
AU - Williamson, Tyler K.
AU - Owusu-Sarpong, Stephane
AU - Imbo, Bailey
AU - Krol, Oscar
AU - Tretiakov, Peter
AU - Joujon-Roche, Rachel
AU - Ahmad, Salman
AU - Bennett-Caso, Claudia
AU - Schoenfeld, Andrew J.
AU - Lebovic, Jordan
AU - Vira, Shaleen
AU - Diebo, Bassel
AU - Lafage, Renaud
AU - Lafage, Virginie
AU - Passias, Peter G.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2024/4
Y1 - 2024/4
N2 - Study design/setting: Retrospective cohort. Objective: Adult spinal deformity (ASD) corrective surgery is often a highly invasive procedure portending patients to both immediate and long-term complications. Therefore, we sought to compare the economic impact of certain complications before and after 2 years. Methods: ASD patients with minimum 3-year data included. Complication groups were defined as follows: any complication, major, medical, mechanical, radiographic, and reoperation. Complications stratified by occurrence before or after 2 years postoperatively. Published methods converted ODI to SF-6D to QALYs. Cost was calculated using CMS.gov definitions. Marginalized means for utility gained and cost-per-QALY were calculated via ANCOVA controlling for significant confounders. Results: 244 patients included. Before 2Y, complication rates: 76% ≥1 complication, 18% major, 26% required reoperation. After 2Y, complication rates: 32% ≥1 complication, 4% major, 2.5% required reoperation. Major complications after 2 years had worse cost-utility (.320 vs.441, P =.1). Patients suffering mechanical complications accrued the highest overall cost ($130,482.22), followed by infection and PJF for complications before 2 years. Patients suffering a mechanical complication after 2 years had lower cost-utility ($109,197.71 vs $130,482.22, P =.041). Patients developing PJF after 2 years accrued a better cost-utility ($77,227.84 vs $96,873.57; P =.038), compared to PJF before 2 years. Conclusion: Mechanical complications had the single greatest impact on cost-utility after adult spinal deformity surgery, but less so after 2 years. Understanding the cost-utility of specific interventions at certain timepoints may mitigate economic burden and prophylactic efforts should strategically be made against early mechanical complications.
AB - Study design/setting: Retrospective cohort. Objective: Adult spinal deformity (ASD) corrective surgery is often a highly invasive procedure portending patients to both immediate and long-term complications. Therefore, we sought to compare the economic impact of certain complications before and after 2 years. Methods: ASD patients with minimum 3-year data included. Complication groups were defined as follows: any complication, major, medical, mechanical, radiographic, and reoperation. Complications stratified by occurrence before or after 2 years postoperatively. Published methods converted ODI to SF-6D to QALYs. Cost was calculated using CMS.gov definitions. Marginalized means for utility gained and cost-per-QALY were calculated via ANCOVA controlling for significant confounders. Results: 244 patients included. Before 2Y, complication rates: 76% ≥1 complication, 18% major, 26% required reoperation. After 2Y, complication rates: 32% ≥1 complication, 4% major, 2.5% required reoperation. Major complications after 2 years had worse cost-utility (.320 vs.441, P =.1). Patients suffering mechanical complications accrued the highest overall cost ($130,482.22), followed by infection and PJF for complications before 2 years. Patients suffering a mechanical complication after 2 years had lower cost-utility ($109,197.71 vs $130,482.22, P =.041). Patients developing PJF after 2 years accrued a better cost-utility ($77,227.84 vs $96,873.57; P =.038), compared to PJF before 2 years. Conclusion: Mechanical complications had the single greatest impact on cost-utility after adult spinal deformity surgery, but less so after 2 years. Understanding the cost-utility of specific interventions at certain timepoints may mitigate economic burden and prophylactic efforts should strategically be made against early mechanical complications.
KW - adult spinal deformity
KW - complications
KW - cost-utility
KW - mechanical failure
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U2 - 10.1177/21925682221122762
DO - 10.1177/21925682221122762
M3 - Article
C2 - 36134677
AN - SCOPUS:85139028202
SN - 2192-5682
VL - 14
SP - 789
EP - 795
JO - Global Spine Journal
JF - Global Spine Journal
IS - 3
ER -