An Economic Analysis of Early and Late Complications After Adult Spinal Deformity Correction

Tyler K. Williamson, Stephane Owusu-Sarpong, Bailey Imbo, Oscar Krol, Peter Tretiakov, Rachel Joujon-Roche, Salman Ahmad, Claudia Bennett-Caso, Andrew J. Schoenfeld, Jordan Lebovic, Shaleen Vira, Bassel Diebo, Renaud Lafage, Virginie Lafage, Peter G. Passias

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
JournalGlobal Spine Journal
DOIs
StateAccepted/In press - 2022

Keywords

  • adult spinal deformity
  • complications
  • cost-utility
  • mechanical failure

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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