Cost Benefit of Implementation of Risk Stratification Models for Adult Spinal Deformity Surgery.

Retrospective cohort study. Assess the extent to which defined risk factors of adverse events are drivers of cost-utility in spinal deformity (ASD) surgery. ASD patients with 2-year (2Y) data were included. Tertiles were used to define high degrees of frailty, sagittal deformity, blood loss, and surgical time. Cost was calculated using the Pearl Diver registry and cost-utility at 2Y was compared between cohorts based on the number of risk factors present. Statistically significant differences in cost-utility by number of baseline risk factors were determined using ANOVA, followed by a generalized linear model, adjusting for clinical site and surgeon, to assess the effects of increasing risk score on overall cost-utility. By 2 years, 31% experienced a major complication and 23% underwent reoperation. Patients with ≤2 risk factors had significantly less major complications. Patients with 2 risk factors improved the most from baseline to 2Y in ODI. Average cost increased by $8234 per risk factor (R The number of defined patient-specific and surgical risk factors, especially those with greater than two, were associated with increased index surgical costs and diminished cost-utility. Efforts to optimize patient physiology and minimize surgical risk would likely reduce healthcare expenditures and improve the overall cost-utility profile for ASD interventions.

Déclaration de conflit d'intérêts

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Peter Gust Passias, MDAllosource: Other financial or material support Cervical Scoliosis Research Society: Research support Globus Medical: Paid presenter or speaker Medtronic: Paid consultant Royal Biologics: Paid consultant Spine: Editorial or governing board SpineWave: Paid consultant Terumo: Paid consultant Zimmer: Paid presenter or speaker. Virginie Lafage, PhD DePuy, A Johnson & Johnson Company: Paid presenter or speaker European Spine Journal: Editorial or governing board Globus Medical: Paid consultant International Spine Study Group: Board or committee member Nuvasive: IP royalties Scoliosis Research Society: Board or committee member The Permanente Medical Group: Paid presenter or speaker. Ferran Pellise, MDAOSpine Deformity Knowledge Forum: Board or committee member DePuy, A Johnson & Johnson Company: Research support European Spine Journal: Editorial or governing board EuroSpine, The Spine Society of Europe: Board or committee member Medtronic: Paid consultant; Research support Scoliosis Research Society: Board or committee member Spanish Spine Society, GEER: Board or committee member Stryker: Paid consultant. Renaud Lafage, MS Nemaris: Stock or stock Options. Munish C Gupta, MD. AO Spine Faculty, travel: Board or committee memberDePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker European Spine Journal-Advisory Board: Editorial or governing board Global Spine Journal-Reviewer: Editorial or governing board Globus Medical: IP royalties; Paid consultant honorarium for faculty: Board or committee member Innomed: IP royalties Johnson & Johnson: Stock or stock Options Medtronic: Paid consultant Spine Deformity, Reviewer: Editorial or governing board SRS-Board of Directors: Board or committee member SRS-IMAST & Education committee: Board or committee member travel: Board or committee member Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Michael Patrick Kelly, MD, MSc, AO Spine: Board or committee memberCervical Spine Research Society: Board or committee member Scoliosis Research Society: Board or committee member Spine: Editorial or governing board. Han Jo Kim, MDAAOS: Board or committee member Alphatec Spine: Paid consultant AO SPINE: Board or committee member Cervical Spine Research Society: Board or committee member HSS Journal, Asian Spine Journal: Editorial or governing board ISSGF: Research support K2M: IP royalties Scoliosis Research Society: Board or committee member Zimmer: IP royalties. Khaled M Kebaish, MDDePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker; Research support Orthofix, Inc.: IP royalties; Paid consultant Orthofix, Inc., K2 medical Inc: Paid presenter or speaker Scoliosis Research Society: Board or committee member Stryker: IP royalties. Alan H Daniels, MDEOS: Paid consultant Medicrea: Paid consultant Medtronic Sofamor Danek: Paid consultant Novabone: Paid consultant Orthofix, Inc.: Paid consultant; Research support Southern Spine: IP royalties Spineart: IP royalties; Paid consultant Springer: Publishing royalties, financial or material support Stryker: Paid consultant. Andrew J Schoenfeld, MDAAOS: Board or committee member Journal of Bone and Joint Surgery - American: Editorial or governing board North American Spine Society: Board or committee member Spine: Editorial or governing board Springer: Publishing royalties, financial or material support Wolters Kluwer Health - Lippincott Williams & Wilkins: Publishing royalties, financial or material support. Jeffrey Gum, MDAcuity: IP royalties; Paid consultant Alan L. & Jacqueline B. 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Ahmet Alanay, MDDePuy, A Johnson & Johnson Company: Research support European Spine Journal: Editorial or governing board Globus Medical: Paid consultant Journal of Bone and Joint Surgery - American: Editorial or governing board Medtronic: Research support Scoliosis Research Society: Board or committee member ZimVie: IP royalties; Paid consultant. Eric O Klineberg, MDAO Spine: Paid presenter or speaker; Research support DePuy, A Johnson & Johnson Company: Paid consultant Medicrea: Paid consultant Medtronic: Paid consultant Stryker: Paid consultant. Breton G Line, BSISSGF: Paid consultant. Robert A Hart, MD, FAAOSAmerican Orthopaedic Association: Board or committee member Cervical Spine Research Society: Board or committee member DePuy, A Johnson & Johnson Company: IP royalties; Paid consultant; Paid presenter or speaker Globus Medical: IP royalties; Paid consultant; Paid presenter or speaker International Spine Study Group: Board or committee member ISSLS Textbook of the Lumbar Spine: Editorial or governing board Medtronic: Paid consultant; Paid presenter or speaker North American Spine Society: Board or committee member Orthofix, Inc.: Paid consultant; Paid presenter or speaker Scoliosis Research Society: Board or committee member SeaSpine: IP royalties Spine Connect: Stock or stock Options Western Ortho Assn: Board or committee member. 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Justin S Smith, MDAlphatec Spine: Stock or stock Options Carlsmed: Paid consultant Cerapedics: Paid consultant DePuy: Research support DePuy, A Johnson & Johnson Company: Paid consultant Journal of Neurosurgery Spine: Editorial or governing board Neurosurgery: Editorial or governing board Nuvasive: IP royalties; Paid consultant; Research support Operative Neurosurgery: Editorial or governing board Scoliosis Research Society: Board or committee member Spine Deformity: Editorial or governing board Stryker: Paid consultant Thieme: Publishing royalties, financial or material support Zimmer: IP royalties; Paid consultant.