TY - JOUR
T1 - Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions
AU - International Spine Study Group
AU - Kim, Andrew H.
AU - Hostin, Richard A.
AU - Yeramaneni, Samrat
AU - Gum, Jeffrey L.
AU - Nayak, Pratibha
AU - Line, Breton G.
AU - Bess, Shay
AU - Passias, Peter G.
AU - Hamilton, D. Kojo
AU - Gupta, Munish C.
AU - Smith, Justin S.
AU - Lafage, Renaud
AU - Diebo, Bassel G.
AU - Lafage, Virginie
AU - Klineberg, Eric O.
AU - Daniels, Alan H.
AU - Protopsaltis, Themistocles S.
AU - Schwab, Frank J.
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
AU - Burton, Douglas C.
AU - Kebaish, Khaled M.
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Scoliosis Research Society 2024.
PY - 2024/11
Y1 - 2024/11
N2 - Purpose: Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion. Methods: ASD patients with > 4-level fusion and 2-year follow-up were included. Index and total episode-of-care costs were estimated using average itemized direct costs obtained from hospital records. Cumulative QALY gained were calculated from preoperative to 2-year postoperative change in Short Form Six-Dimension (SF-6D) scores. The TL and UT groups comprised patients with upper instrumented vertebrae (UIV) at T9-T12 and T2-T5, respectively. Results: Of 566 patients with type N or L curves, mean age was 63.2 ± 12.1 years, 72% were female and 93% Caucasians. Patients in the TL group had better sagittal vertical axis (7.3 ± 6.9 vs. 9.2 ± 8.1 cm, p = 0.01), lower surgical invasiveness (− 30; p < 0.001), and shorter OR time (− 35 min; p = 0.01). Index and total costs were 20% lower in the TL than in the UT group (p < 0.001). Cost/QALY was 65% lower (492,174.6 vs. 963,391.4), and 2-year QALY gain was 40% higher, in the TL than UT group (0.15 vs. 0.10; p = 0.02). Multivariate model showed TL fusions had lower total cost (p = 0.001) and higher QALY gain (p = 0.03) than UT fusions. Conclusion: In Schwab type N or L curves, TL fusions showed lower 2-year cost and improved QALY gain without increased reoperation rates or length of stay than UT fusions. Level of evidence: III.
AB - Purpose: Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion. Methods: ASD patients with > 4-level fusion and 2-year follow-up were included. Index and total episode-of-care costs were estimated using average itemized direct costs obtained from hospital records. Cumulative QALY gained were calculated from preoperative to 2-year postoperative change in Short Form Six-Dimension (SF-6D) scores. The TL and UT groups comprised patients with upper instrumented vertebrae (UIV) at T9-T12 and T2-T5, respectively. Results: Of 566 patients with type N or L curves, mean age was 63.2 ± 12.1 years, 72% were female and 93% Caucasians. Patients in the TL group had better sagittal vertical axis (7.3 ± 6.9 vs. 9.2 ± 8.1 cm, p = 0.01), lower surgical invasiveness (− 30; p < 0.001), and shorter OR time (− 35 min; p = 0.01). Index and total costs were 20% lower in the TL than in the UT group (p < 0.001). Cost/QALY was 65% lower (492,174.6 vs. 963,391.4), and 2-year QALY gain was 40% higher, in the TL than UT group (0.15 vs. 0.10; p = 0.02). Multivariate model showed TL fusions had lower total cost (p = 0.001) and higher QALY gain (p = 0.03) than UT fusions. Conclusion: In Schwab type N or L curves, TL fusions showed lower 2-year cost and improved QALY gain without increased reoperation rates or length of stay than UT fusions. Level of evidence: III.
KW - Adult spinal deformity
KW - Cost
KW - Quality-adjusted life year
KW - Thoracolumbar fusion
KW - Upper thoracic fusion
UR - http://www.scopus.com/inward/record.url?scp=85200416203&partnerID=8YFLogxK
U2 - 10.1007/s43390-024-00919-7
DO - 10.1007/s43390-024-00919-7
M3 - Article
C2 - 39090432
AN - SCOPUS:85200416203
SN - 2212-134X
VL - 12
SP - 1783
EP - 1791
JO - Spine deformity
JF - Spine deformity
IS - 6
ER -