Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention

被引：8

作者：

Passias, Peter G. ^{[1
,2
,19
]}

Ahmad, Waleed ^{[1
,2
]}

Kummer, Nicholas ^{[1
,2
]}

Lafage, Renaud ^{[3
]}

Lafage, Virginie ^{[3
]}

Kebaish, Khaled ^{[1
,2
]}

Daniels, Alan ^{[4
]}

Klineberg, Eric ^{[5
]}

Soroceanu, Alex ^{[6
]}

Gum, Jeffrey ^{[7
]}

Line, Breton ^{[8
]}

Hart, Robert ^{[9
]}

Burton, Douglas ^{[10
]}

Eastlack, Robert ^{[11
]}

Jain, Amit ^{[12
]}

Smith, Justin S. ^{[13
]}

Ames, Christopher P. ^{[14
]}

Shaffrey, Christopher ^{[15
,16
]}

Schwab, Frank ^{[3
,18
]}

Hostin, Richard ^{[17
]}

Bess, Shay ^{[8
]}

机构：

[1] NYU Langone Orthoped Hosp, New York Spine Inst, Dept Orthoped Surg, New York, NY USA

[2] NYU Langone Orthoped Hosp, New York Spine Inst, Dept Neurol Surg, New York, NY USA

[3] Hosp Special Surg, Dept Orthoped, New York, NY USA

[4] Brown Univ, Warren Alpert Med Sch, Dept Orthoped, Providence, RI USA

[5] Univ Calif Davis, Dept Orthopaed Surg, Davis, CA USA

[6] Univ Calgary, Dept Orthoped, Calgary, AB, Canada

[7] Norton Leatherman Spine Ctr, Louisville, KY USA

[8] Presbyterian St Lukes Rocky Mt Hosp Children, Dept Spine Surg, Denver Int Spine Clin, Denver, CO USA

[9] Swedish Neurosci Inst, Dept Orthopaed Surg, Seattle, WA USA

[10] Univ Kansas, Dept Orthopaed Surg, Med Ctr, Kansas City, KS USA

[11] Scripps Clin, Div Orthopaed Surg, La Jolla, CA USA

[12] Johns Hopkins Med Ctr, Dept Neurol Surg, Baltimore, MD USA

[13] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA

[14] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

[15] Duke Univ, Dept Neurosurg, Med Ctr, Durham, NC USA

[16] Duke Univ, Dept Orthopaed Surg, Med Ctr, Durham, NC USA

[17] Baylor Scoliosis Ctr, Dept Orthopaed Surg, Dallas, TX USA

[18] Lenox Hill Hosp, Dept Orthopaed, Northwell Hlth, New York, NY USA

[19] Orthoped Hosp, New York Spine Inst, NYU Langone Med Ctr, NYU Sch Med,Div Spinal Surg,Dept Orthoped Surg, 301 East 17th St, New York, NY 10003 USA

来源：

NEUROSURGERY | 2022年 / 90卷 / 01期

关键词：

Economics; Frailty; Spinal deformity; Cost-effectiveness; QALY; Utility gained; OSWESTRY DISABILITY INDEX; NUMERIC RATING-SCALES; BACK;

D O I：

10.1227/NEU.0000000000001756

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation. OBJECTIVE:To investigate costs associated with ASD and frailty. METHODS: Patients with ASD (scoliosis >= 20 degrees, sagittal vertical axis [SVA] >= 5 cm, pelvic tilt >= 25 degrees, or thoracic kyphosis >= 60 degrees) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated. RESULTS: Five hundred ninety-two patients with ASD were included (59.8 +/- 14.0 yr, 80% F, body mass index: 27.7 +/- 6.0 kg/m(2), Adult Spinal Deformity-Frailty Index: 3.3 +/- 1.6, and Charlson Comorbidity Index: 1.8 +/- 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149). CONCLUSION: Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.

引用

页码：148 / 153

页数：6

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