Faculty Bibliography

BACKGROUND CONTEXT: Operative adult spinal deformity (ASD) patients are particularly vulnerable to the deleterious impact of comorbidities, thus preoperative optimization of modifiable health factors may improve surgical outcomes and improve cost effectiveness. PURPOSE: To assess impact of preoperative optimization of modifiable health conditions on perioperative complications and operative costs in patients undergoing surgical correction of ASD. STUDY DESIGN/SETTING: Retrospective analysis of patients prospectively enrolled in a single center ASD database. PATIENT SAMPLE: This study included 269 ASD patients. OUTCOME MEASURES: Perioperative complications, cost effectiveness.
METHOD(S): ASD patients with perioperative data were included. Optimization of diabetes (DM), osteoporosis, and nutritional status was assessed. Patients with DM were considered optimized (Opt) if preop HbA1c<=7%. Those with osteoporosis were Opt if treated with an FDA-approved drug prior to surgery. In contrast, nutritional status was assessed by ranking patients into quartiles (Q1-Q4) by baseline BMI. Q1 (low BMI) and Q4 (high BMI) were considered N-Opt. Total Costs (TC) were calculated from average Medicare DRG reimbursement. Where applicable, preop (<=90 days) costs incurred that were directly related to optimization (eg, drugs) were added to TC. Multivariable analyses assessed perioperative outcomes while accounting for surgical and demographic differences between groups.
RESULT(S): A total of 269 patients were included (24.2% DM; 15.2% osteoporotic). Of diabetics (70.8% Opt; 29.2% N-Opt), Opt patients had 94.1% lower odds of wound infection (OR: 0.059 [0.007, 0.491], p=.009) and 89.3% lower odds of 90-day readmission (OR: 0.107 [0.033, 0.352], p.05), odds of periop complications were significantly reduced for patients in Q2 (OR: 0.354 [0.200, 0.625], p <.001) and Q3 (OR: 0:380 [0.193, 0.751], p=.005) and TC were significantly lower in Opt quartiles (all p <.001).
CONCLUSION(S): Despite accounting for surgical differences and costs of preoperative interventions, total costs were significantly lower in optimized patients. Thus, optimizing modifiable health conditions prior to surgery may benefit ASD patients by reducing perioperative complications while also minimizing utilization of hospital resources and lowing total costs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Artificial intelligence (AI) has enhanced the orthopedic surgical tool kit by introducing a broad range of analytical advances that may offer enhanced preoperative planning, intraoperative robotic or navigational guidance and prediction of postoperative complications. However, there remains a paucity of literature in regards to the utility of AI in adult spinal deformity (ASD)-corrective surgery. PURPOSE: To access the impact of AI utilization on ASD-corrective surgery outcomes. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Artificial intelligence, perioperative complications, radiographic outcomes METHODS: Operative ASD patients with complete baseline (BL) and 2-year (2Y) radiographic/HRQL data were stratified by AI-based utilization and robotic or navigational assistance in pre- and peri-operative course (AI+) or not (AI-). Corrections were based on AI models linked to age, proportional alignment and frailty status algorithms to predict outcomes, junctional failure and thoracic compensations. Means comparison tests and regression analysis assessed differences between patient groups.
RESULT(S): There were 158 patients included (57 AI+, 101 AI-). The cohort was 50% female, mean age of 58.8 yrs, BMI 31.6 kg/m2, CCI 3.9 and 6.6 levels fused. At baseline, patient groups were comparable in terms of BL radiographic parameters, all p <.05. Surgically, AI+ had significantly shorter operative times and EBL than AI-, both p <.05. AI+ had more combined approaches and less osteotomies overall, both p <.05. Postoperatively, AI+ patients were noted to have significantly improved segmental alignment in terms of decreased PT (p=0.006), and improved global alignment per decreased TPA and SVA by 2Y, both p < 0.05. Compared to AI-, AI+ patients had a lower overall complication rate by 2Y (28.1% vs 47.5%), p < 0.05. in a multivariate analysis controlling for age, CCI, and invasiveness, AI+ patients were 61.6% less likely to experience a perioperative complication (OR.384 [CI.149-.989], p=0.047).
CONCLUSION(S): This study demonstrates that when using artificial intelligence-based technologies, patients demonstrated lower intraoperative invasiveness, increased likelihood of reaching radiographic alignment targets, and decreased complication rates specifically in the perioperative period. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Bone Morphogenetic Protein-2 (BMP-2) has not shown superior benefit in terms of overall cost-effectiveness after implementation during adult spinal deformity (ASD) surgery. However, it remains to be shown whether certain discrete populations do obtain cost-utility from use of BMP-2. PURPOSE: Generate a score to determine usage of BMP-2 and correlate with rates of pseudarthrosis. STUDY DESIGN/SETTING: Retrospective cohort study of a single-center ASD database. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Cost utility, pseudarthrosis.
METHOD(S): ASD patients with BL and 2-year(2Y) data included. BMP-2 kit size and cost: small - 4.2 mg ($21,800), medium - 8.4 mg ($23,667), large - 12 mg ($25,617). Published methods converted ODI to SF-6D. QALYs utilized a 3% discount rate for residual decline. Cost was calculated using the PearlDiver database and assessed for Complications and Comorbidities and Major Complications and Comorbidities according to CMS.gov definitions. Binary logistic regression analyses determined significant predictors for development of pseudarthrosis. Established weights were generated for predictive variables via back-step logistic regression for a risk score to predict development of pseudarthrosis. Risk score was then validated via Receiver Operating Characteristic (ROC) curve method analysis. Categories via conditional inference tree (CIT) analysis-derived thresholds were tested for cost-utility of BMP-2 usage. Marginalized means for utility gained and Cost per QALY were calculated within each risk score category, controlling for age, history of prior fusion, and baseline deformity and disability.
RESULT(S): Included: 387 ASD patients. Of 387, 64% received BMP-2 (1% small, 4% medium, 59% large). There were 17 (4.4%) of patients that developed pseudarthrosis by two years, 9 (2.3%) of which underwent reoperation. BMP-2 use, regardless of kit size, did not significantly lower pseudarthrosis rates overall (OR: 0.4, [0.2-1.04]). A predictive risk score for development of pseudarthrosis was formed by the following preoperative variables: age, frailty, history of diabetes, osteoporosis, depression, ASA grade, and baseline L4-S1 and T1PA. Via ROC method, this predictive risk score generated an AUC of 0.87. Following CIT machine learning, thresholds for the BMP Risk Score were derived: >5 No Risk (NoR), 3-5 Low Risk (LowR), 2-3 Moderate Risk (ModR), and <2 High Risk (HighR). The rates of pseudarthrosis for each category were: NoR - 0%; LowR - 1.6%; ModR - 9.3%; HighR - 24.3%. When assessing BMP-2 use and its cost-utility within each group, patients receiving BMP-2 had similar QALYs to those that did not receive BMP-2 (0.163 vs 0.171, p=.65). BMP-2 usage had significantly worse cost-utility in both NoR and LowR cohorts (both p<.05). In ModR patients, BMP-2 usage had equivocal cost-utility ($680,532.35 vs $580,380.21, p=.14). In the HighR cohort, the cost-utility difference narrowed even further (BMP-2 use: $743,155.21 vs $719,628.79, p=.82).
CONCLUSION(S): Our study shows BMP-2 has equivocal cost-utility within those at moderate and high risk for developing pseudarthrosis within two years following spinal deformity correction. The generated predictive score can better aid spine surgeons assess risk and enhance justification for the use of BMP-2 during surgical intervention for adult spinal deformity. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Several studies have suggested that Hounsfield units (HU) in the spine are associated with increased complications for adult spinal deformity (ASD) patients. PURPOSE: The aim of this study is to assess whether there exists a threshold for HU that is associated with increased blood loss following ASD surgery. We hypothesize that HU below thresholds on spinal CT are predictive of increased blood loss during surgery and implant complications within 90 days after surgery for ASD. STUDY DESIGN/SETTING: Retrospective analysis. PATIENT SAMPLE: ASD patients who had HU measured in the spine were identified from a multicenter database. OUTCOME MEASURES: High Intraoperative blood loss and implant complications within 90 days of surgery.
METHOD(S): HU at L1, upper instrumented vertebrae (UIV) and total averages were assessed. Threshold linear regression with Bayesian information criteria was utilized to identify optimal cut-offs for predicting high blood loss (>2100mL, top 25% by volume) or any implant complications within 90 days. Implant complications included loosening, breakage and dislocation of rods or screws. Multivariable logistic regression was utilized controlling for age, gender, comorbidity, osteotomy and levels fused.
RESULT(S): Of 527 patients included, the mean age was 61+/-14. Mean L1 HU was 154.59+/-87, UIV HU was 175.1+/-304, and total average HU was 165+/-168. There were 59 patients with high blood loss (mean 5,026+/-233ml) and 467 with low blood loss (1,331+/-39.5ml). Threshold regression analysis identified that a cut-off of =140.33 was optimal for predicting high blood loss and =99.75 total average HU was optimal for predicting implant complications within 90 days of surgery. On multivariable analysis, L1 HU less than 140 was associated with 1.57x higher odds of high blood loss (P=0.032). Total average HU less than 100 was associated with a 3.6x higher odds of having an implant related failure within 90 days of surgery (P=0.035).
CONCLUSION(S): In this prospective multi-center study, Those with L1 HU=140 had a 1.52x higher odds of high blood loss. Patients with an average HUof =100 have 3.6x higher odds of implant related complication within 90 days of surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The Dubousset Functional Test (DFT) is a novel functional assessment tool. It has been shown that patients with spinal pathology take significantly longer to complete the DFT than do control patients. There has been a recent focus in the literature on using functional assessment to predict patient outcomes. PURPOSE: To investigate the relationship between patients' performance of the novel four-component functional test proposed by Dubousset, sagittal alignment and patient-reported outcome measures PROMs. STUDY DESIGN/SETTING: Prospective, single center study. PATIENT SAMPLE: Patients presenting to a single institution for lumbar degenerative disease or spinal deformity. OUTCOME MEASURES: The correlation between time to complete DFT, radiographic measures of sagittal alignment and PROMs.
METHOD(S): This is a prospective, single-center study including primary patients who presented for evaluation of lumbar degenerative disease and spinal deformity. DFT is a test which assesses 4 domains: Up and Walking Test (UWT), Steps Test (ST), Down and Sitting Test (DST), Dual Tasking Test (DTT). The UWT asks the patient to sit-to-stand unassisted, walk 5 m, and sit unassisted. ST asks the patient to ascend 3 steps, turn, and descend 3 steps. DST asks the patient to sit from standing, and then stand from sitting, both unassisted. Finally, DTT asks the patient to walk 5 m and back while counting down from 50 by 2. Each test was timed, and performance was scored in seconds required to finish the test. Spinopelvic radiographs and PROMs (EQ5D, ODI, SF12) were collected. DFT performance was stratified by 40th (Fast) and 60th (Slow) percentile cutoffs. Radiographic sagittal parameters were compared between groups. Regression models were built to predict DFT domains performances using alignment parameters.
RESULT(S): A total of 55 patients were included (52y, 66%F, BMI 25.6). Patients in all DFT Slow domains had significantly worse ODI (all above 40), EQ5D (all below 0.5), and worse SF12_PCS (all below 32) except DTT Slow patients who had a comparable PCS to Fast. UWT Slow patients had significantly greater PI-LL (15 vs 2), lower LL (45 vs 60), and greater PT (22 vs 12); DTT Slow had greater PT (22 vs 11); DST Slow had greater PT (23 vs 12), and greater PI-LL (13 vs 1); ST and DTT slow patients had comparable radiographic parameters to ST and DTT Fast; however, they were older (59 vs 43 ys) (all p <0.05). Greater PT correlated with longer time to perform UWT and DST (r=0.451, r=0.488, respectively, p < 0.05). Greater PI-LL correlated with longer UWT (r=0.349) and loss of LL with longer ST (r=0.416), all p <0.05. Notably, loss of L4-S1 correlated with slower UWT (r=0.377, p <0.05). Regression models revealed that PT, PI-LL and SVA together predict UWT with r=0.472, DST with r=0.370, DTT with r=0.310, and ST with r=0.149.
CONCLUSION(S): The Dubousset Functional Test correlates with sagittal radiographic parameters and PROMs. PT, SVA, and PI-LL were able to predict up to 25% of patients' performance on the functional testing. Although radiographic parameters are helpful in guiding ASD treatment, they should be supplemented with other forms of patients' assessment which may include functional testing. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. PURPOSE: To evaluate the impact of specific complications on patient reported health domains compared to patients with no complications. STUDY DESIGN/SETTING: Prospective, multicenter, propensity score matched analysis. PATIENT SAMPLE: ASD patients enrolled into a prospective multi-center study. OUTCOME MEASURES: Oswestry Disability Index, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), postoperative complications.
METHOD(S): Surgically treated ASD patients enrolled into a multicenter study were assessed for postoperative complications requiring surgery including wound (WOUND), pseudoarthrosis (PSEUDO), neurologic (NEURO) and malalignment (MAL) and matched to patients with no complications (NOCOMP) using inverse probability weighting for demographic, radiographic and surgical variables. Health domains for SRS-22r, and SF-36 were evaluated at regular time intervals, domain scores normalized to the date of revision surgery, and compared to patients with no complications at minimum 2-year follow-up.
RESULT(S): A total of 566 of 1130 were analyzed, average 3.6 yrs (range: 1.9 to 9). WOUND (n=12) compared to NOCOMP (n=390) had worse SF-36 physical function(21.7 vs 27.4), social function(19.6 vs 28.9), general health (-7.3 vs 8.9) and vitality (-0.9 vs 26.6,p < 0.05). PSEUDO (n=64) was worse than NOCOMP for SRS-22r function, 1.4 vs 2.1, and SF-36 social function, (17.1 vs 28.9) (p < 0.05). NEURO (n=28) was worse than NOCOMP for SRS-22r (0.9 vs 2.1), SF-36 bodily pain (14.7 vs 35.7) and social function (13.4 vs 28.9) (p < 0.05). MAL (n=72) was worse than NOCOMP for SRS-22r pain, (2.7 vs 3.4), function (1.2 vs 2.1), self-image (3.0 vs 3.9), SF-36 bodily pain (27.6 vs 35.7), physical function (18.7 vs 27.4), and social function (11.6 vs 28.9) (p < 0.05).
CONCLUSION(S): Counter to previous reports, specific postoperative complications requiring surgery uniquely impact specific health domains, resulting in worse patient reported quality of life compared to ASD patients with no complications. Social function was negatively impacted for all complications, while wound complications negatively impacted patient perceived general health and vitality and patients with malalignment requiring surgery reported worse self-image. These data highlight new findings that postoperative complications have a negative impact on specific aspects of ASD quality of life that can undermine the potential benefits of ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: While reimbursement is centered on 90-day outcomes, some patients persevere through these short-term, transient complications and manage to still achieve optimal, long-term outcomes. PURPOSE: Assess whether achieving optimal alignment suffering similar perioperative complications compared to suboptimally-aligned peers are inhibited from reaching long-term clinical success and better cost-utility. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective adult spinal deformity (ASD) database. PATIENT SAMPLE: A total of 1,541 patients. OUTCOME MEASURES: Cost-per-QALY, radiographic realignment, clinical outcomes.
METHOD(S): Operative ASD pts with 2Y data were included. Optimal radiographic outcome was defined by SRS-Schwab low deformity in PI-LL, matched in T1PA and being aligned in PI-based PT at 6 weeks. After stratifying pts based on meeting optimal outcome, multivariate analysis controlling for baseline demographics was used to determine significance for complications and hospital-acquired conditions (HACs; DVT/PE, UTI, deep/superficial infection). Calculated Cost per QALY for each time point by 2Y.
RESULT(S): There were 917 ASD pts included. Regarding approach, 69% posterior approach, 31% combined. Groups: 131 were "optimal" (O) and 786 were "not optimal" (NO). Means comparison tests revealed significant differences in age, BMI, but not gender or frailty. The NO group had fewer osteotomies and a lower Invasiveness Index. Analysis of perioperative complications showed that the O group suffered equivocal perioperative complications (58.0% vs 52.2% in the NO group; p=.173) and rates of HACs (9.0% vs. 8.9%, p=.810). Analysis of long-term complications showed that patients in the NO group suffered more major neurological (p=.015) and major mechanical complications (p=.025), and more reoperations (28.7% vs 19.9%; p=.037). When controlling for baseline deformity, age, BMI and frailty, Optimal Outcome patients more often met Best Clinical Outcome (21.5% vs. 11.7%, p=.002). Cost-utility adjusted analysis with determined no difference in the two groups by 6 weeks and 6 months. However, the O group generated significantly better cost-utility by one year, which maintained lower Costs per QALY (p=.005) at two years in favor of the O group.
CONCLUSION(S): Despite incurring equivocal perioperative complications, patients who met our optimal outcome criteria experienced significantly less mechanical complications and reoperations by 2 years, leading to a better long-term cost-utility overall. Accordingly, a higher, transient perioperative complication profile should not preclude surgical correction and future policy efforts should place more consideration on the long-term for outcome measures in adult spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Surgical correction of adult spinal deformity (ASD) has been associated with superior alignment and functional outcomes. However, postoperative complication rates remain relatively high. The extent to which potentially modifiable patient-related factors can influence complication rates in adult spinal deformity patients has not been effectively evaluated. PURPOSE: Evaluate the association between modifiable patient-related factors on complications following ASD corrective surgery. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 689 ASD patients. OUTCOME MEASURES: Complication and reoperation rates.
METHOD(S): ASD patients with 2-year (2Y) data were included. Complication groups were defined as follows: 1) any complication; 2) major; 3) medical (cardiac event, ileus, etc.); surgical (site infection, wound dehiscence, etc.); 5) major mechanical (implant failure, rod fracture); 6) major radiographic (PJF [proximal junctional failure], pseudarthrosis, adjacent segment disease); and 7) reoperation. Modifiable risk factors included current smoker, obesity (BMI >30kg/m²), osteoporosis, alcohol use, depression (BL SF-36 MCS <35, perMatcham), psychiatric diagnosis and hypertension. Patients were stratified by BL deformity severity in T1PA (LowDef/HighDef) and age above or below 65 (Young/Older). Means comparison tests assessed prevalence of modifiable risk factors present in those developing specified complications. Binary logistic regression analysis was used to adjust for confounders.
RESULT(S): A total of 480 ASD patients met inclusion criteria (age 59+/-15 yrs, 77%F, BMI 27+/-5 kg/m², CCI: 1.7+/-1.7). By 2Y, comp rates: 72% one complication, 28% major, 21% medical, 27% surgical, 11% major radiographic, and 8% had a major mechanical complication. A total of 106 patients (22%) required reoperation. Overall, 318 patients (66%) had at least one of the preoperative risk factors. Age-Deformity Groups: 32% Young LowDef, 19% Young HighDef, 18% Older LowDef, 31% Older HighDef. Within Young LowDef, patients with osteoporosis were more likely to suffer either a major mechanical or radiographic comp (both OR >6, p<.05), although this trend was not seen in the overall cohort. Young HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR: 2.8, [1.04-8.6]; p=.045), while patients with depression or a psychiatric diagnosis suffered major radiographic comps and underwent reoperation more often. Older patients with HighDef developed significantly more complications when diagnosed with depression, including major radiographic comps (23% vs 8%, OR: 3.5, [1.1-10.6]; p=.03). Overall, when controlling for baseline deformity, frailty, and osteoporosis, a diagnosis of depression proved to be a significant risk factor for development of major radiographic complications (OR: 2.4, [1.3-4.5]; p=.005).
CONCLUSION(S): Certain modifiable patient-related factors, especially mental health status, are associated with increased risk for complications following spinal deformity surgery. Therefore, with consideration to clinical presentation, elaborate on the utility in medical intervention prior to undergoing spinal deformity corrective surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: As surgical techniques for deformity correction evolve towards minimizing tissue trauma, further clarity is warranted to define differences in complication profiles between cMIS and open surgeries. PURPOSE: To compare cMIS and open surgery reoperation rates and identify contributing etiologies to reoperation in each cohort. STUDY DESIGN/SETTING: Prospective multicenter observational series. PATIENT SAMPLE: Database enrollment required age =18 years, adult spinal deformity and circumferential minimally invasive spine surgery. OUTCOME MEASURES: Reoperation rate, patient reported outcomes (PROMS), spinopelvic parameters, mechanical failures (defined as rod breakage/dislocation, screw breakage/loosening, set screw loosening, proximal/distal junctional kyphosis, pseudoarthrosis) and other factors contributing to re-operation such as wound infection, medial breach, nerve impingement by screw, vertebral body fracture, sagittal/coronal imbalance, and wound infection.
METHOD(S): A total of 85 patients (pts) with cMIS for ASD with 2-year follow-up (2YFU) were identified and propensity matched to 85 patients in open cohort. Propensity matching was performed based on pre-operative PT, PI-LL, BMI, and SVA. Patient demographic variables, reoperation rate, and complications contributing to reoperation were compared with uni- and multi-variate analysis at any time in each cohort (33 open, 17 cMIS). PROMS at 2YFU were compared in the reoperated cohorts.
RESULT(S): Total of 33 reoperation in the open cohort vs 17 in cMIS were identified. The reoperation rate was significantly higher in the open cohort at 39% (33/85) compared to 20% (17/85) in the cMIS cohort (P= 0.012). The reoperation rate in open cohort related to mechanical failure was 52% (17/33) compared to 35% (6/17) in cMIS cohort (P= 0.43). No significant difference was found in rates of specific etiologies contributing to complications in the cMIS vs open reoperation cohorts under uni- and multivariate analysis. The change in spinopelvic parameters among the two reoperation cohorts at 2YFU were statistically not significant (deltaCVA, deltaSVA, deltaPI-LL, deltaPT, deltaLL CA, deltaTL CA). Under univariate analysis, the following PROMS were similar: ODI, NRS Leg and Back Pain, EQ5D, EQ5D-VAS, SF-36 PCS,SF-36 MCS. However, SRS-22 in open cohort was significantly higher at 2YFU (3.55 +/- 0.73 open vs. 3,10 +/- 0.56 MIS, p = 0.029).
CONCLUSION(S): Findings in our ongoing study show that cMIS procedures were associated with a significantly lower reoperation rate compared to open surgical approaches. PROMS and the change in spinopelvic parameters were similar at 2YFU in both reoperated cohorts (except for SRS-22 favored open cohort). FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Preoperative rehabilitation programs have recently been implemented to prepare patients for surgery and to promote patient health. In this cohort, preoperative rehabilitation consisted of physical and mental components. Patients were referred for physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with a review of postop protocols to do at home, including gait and balance training. Patients were also referred for cognitive behavioral therapy for 2 weeks to prepare for the stress of surgery. Patients were excluded if they presented with any of the following at baseline (BL): severe neurological deficit (<3/5), minimal ambulation or current depression/anxiety. PURPOSE: Identify if preoperative rehabilitation influences patients' ability to recover and adult spinal deformity correction cost-effectiveness. STUDY DESIGN/SETTING: Retrospective cohort. PATIENT SAMPLE: This study included 689 adult spinal deformity patients. OUTCOME MEASURES: Preoperative rehabilitation, recovery kinetics, cost effectiveness.
METHOD(S): Adult spinal deformity patients with baseline (BL) and two-year (2Y) follow-up, and available preoperative rehabilitation and economic data were included. Patients were divided on whether or not they completed a preoperative rehabilitation assignment (Prehab) or not (no Prehab). Normalized HRQL scores at BL and follow-up intervals (6W, 1Y, 2Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost was calculated using the PearlDiver database. This data is representative of national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life year (QALY) at 2Y were calculated. Multivariate logistic regression analysis assessed patient reported outcomes and cost adjusting for baseline and surgical characteristics.
RESULT(S): A total of 100 patients were included (36 Prehab, 64 no Prehab). Age (59.2 vs 56.2), gender (F: 58% vs 45%), body mass index (32.9 vs 31.4), and Charlson Comorbidity Index (3.8 vs 3.9) were similar between groups (P >0.05). OpTime, EBL, and length of construct were similar between groups (p >0.05). Normalized HRQLs determined Prehab patients to exhibit better ODI than no Prehab patients at 2Y follow-up, p 0.05. Cost effectiveness was determined via cost per QALY: Prehab = $14,463 and not Prehab = $45,515, p <0.05.
CONCLUSION(S): Patients who had a preoperative rehabilitation prior to corrective surgery were in a better state of postoperative back disability at two-year follow-up. While both patient cohorts had improvement following surgery, patients with preoperative rehabilitation had greater utility gained at two-year follow-up. Costs by procedure and cost effectiveness were better for patients who had preoperative rehabilitation. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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