Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery

Lee, Thomas J; Thomas, Alexander A; Grandhi, Nikhil; Galetta, Matthew S.; Goyal, Dhruv K.C.; Fang, Taolin; Schroeder, Gregory D.; Kepler, Christopher K.; Vaccaro, Alexander R.

doi:10.1097/bsd.0000000000000982

Cited by 18 publications

(16 citation statements)

References 38 publications

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“…As government and third-party payers in the United States continue to emphasize value-based care, the determination of cost-effectiveness for various procedures serves a critical role in spine surgery. 20,24 Frailty is a complex spectrum disorder with numerous etiologies. 25 Cervical deformity surgery is widely known to be associated with a large initial healthcare expenditures and a high rate of complications.…”

Section: Discussionmentioning

confidence: 99%

“…Two-year reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for all services rendered within a 30-day window, including estimates regarding costs of postoperative complications, outpatient healthcare encounters, revisions, and medical-related readmissions. After accounting for complications and comorbidities, major complications and comorbidities, length of stay, revisions, and death, cost per QALY at two-year follow-up was calculated 20–24…”

Section: Methodsmentioning

confidence: 99%

“…After accounting for complications and comorbidities, major complications and comorbidities, length of stay, revisions, and death, cost per QALY at two-year follow-up was calculated. [20][21][22][23][24] Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved.…”

Section: Cost Calculationmentioning

confidence: 99%

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The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

Passias

Kummer

Williamson

et al. 2022

Spine

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Summary of Background Data. The influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning. Objective. To assess the influence of baseline frailty status on the economic burden of CD surgery Study Design. Retrospective cohort. Materials and Methods. CD patients with frailty scores and baseline and two-year Neck Disability Index data were included. Frailty score was categorized patients by modified CD frailty index into not frail (NF) and frail (F). Analysis of covariance was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline sacral slope, T1 slope minus cervical lordosis, C2–C7 angle, C2–C7 sagittal vertical axis. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for services within a 30-day window including length of stay and death. This data is representative of the national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life-year (QALY) at two years was calculated for NF and F patients. Results. There were 126 patients included. There were 68 NF patients and 58 classified as F. Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P>0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P=0.793), resulting in equivocal costs per QALYs for both patients at two years ($90,113.79 vs. $80,866.66, P=0.097). Conclusion. F and NF patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to comparative cost-effectiveness with NF patients based on cost per QALYs at two years. Surgical correction for CD is an economical healthcare investment for F patients when accounting for anticipated utility gained and cost-effectiveness following the procedure. Level of Evidence. III.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

Passias

Kummer

Williamson

et al. 2022

Spine

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“…13 This model allows for shared-decision making grounded on each individual goal of care, and in turn, optimized resource utilization and asset allocation with potentially decreased costs, as more suitable interventions may then be chosen that more directly align with the patient's goals of treatment. 13,14 Mental health impairments are highly prevalent in the spine surgical population undergoing cervical and lumbar procedures, with an estimated depression prevalence of >50% among surgical candidates. 3 Still, few authors have addressed the utility of measuring the predictive value of preoperative mental health scores (ie, PHQ-9) on ACDF outcomes, while many have evaluated this relationship with lumbar fusion outcomes (demonstrating a pattern by guest on July 24, 2022 http://ijssurgery.com/ Downloaded from of poorer outcomes among those with lower baseline mental functioning).…”

Section: Discussionmentioning

confidence: 99%

Anterior Cervical Discectomy and Fusion Results in Clinically Significant Improvements in Patients With Preoperative Sleep Difficulties

et al. 2022

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Background: Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF).Methods: A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. MCID achievement was determined by comparing postoperative PROM improvement from baseline to previously established values. Logistic regression assessed responses to each individual question of the preoperative PHQ-9 as predictors of MCID achievement in each other PROMs.Results: Sixty-six ACDF patients were included with a mean age of 47.2 years. Herniated nucleus pulposus was the most common preoperative spinal diagnosis (95.6%). The mean operative duration was 50.3 minutes, the mean estimated blood loss was 27.5 mL, and most patients were discharged on postoperative day 0 (81.8%). A majority of patients achieved MCID for all measures except SF-12 PCS. PHQ-9 question 3 significantly predicted MCID achievement for VAS neck (P = 0.045), VAS arm (P = 0.049), and SF-12 PCS (P = 0.037). No other PHQ-9 items or overall PHQ-9 scores significantly predicted MCID achievement.Conclusion: Question 3 of the PHQ-9 regarding "trouble falling asleep, staying asleep, or sleeping too much" significantly predicted clinically meaningful improvement in neck pain, arm pain, and physical function following ACDF, although overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery.Clinical Relevance: Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF.Level of Evidence: 3. Cervical SpineKeywords: anterior cervical discectomy and fusion (ACDF), patient health questionnaire-9 (PHQ-9), patient-reported outcome measures (PROMs)

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“…2 Overall there is a need for future study of the cost-effectiveness of robotic-assisted orthopedic surgeries to understand their place in value-based care. 3,44,45…”

Section: Spinal Surgeriesmentioning

confidence: 99%

Robotic Surgical Systems for Orthopedics

Smith¹,

Picheca²,

Mahood³

2022

cjht

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Robotic surgical systems for orthopedics are used primarily in procedures to treat osteoarthritis (either partial or full knee replacement or total hip replacement), and in procedures to treat degenerative spinal disease or spinal alignment or curvature abnormalities. Robotic-assisted orthopedic surgeries are intended to improve the accuracy and precision of implant placement and may lead to improved clinical outcomes, shorter recovery time, and fewer revisions. Evidence around their clinical effectiveness is still limited, however, the trend suggests that robot-assisted surgeries may be comparable, or marginally better, in clinical effectiveness when compared to conventional techniques. Robotic-assisted surgery can reduce the length of inpatient stay, but it involves longer operative times. Larger, long-term, randomized controlled trials are needed to confirm their comparative effectiveness. Robotic surgical systems for orthopedics are costly because their initial capital purchase is high, and each procedure requires the use of consumables. However, they may reduce length of stay, which can free up inpatient beds, and reduce rates of revision, which can be cost saving. While some evidence suggests that robotic-assisted knee and hip replacements can be cost-effective, there is limited cost-effectiveness information specific to Canadian contexts. There is a steep learning curve to adopting robotic surgical systems and teams require training and ongoing technical support to ensure that the unit is used to its full capacity. The roles of team members, particularly nursing staff, may change and require advanced technical knowledge. Robotic surgical systems are constantly evolving, integrating new and improved components such as augmented reality, artificial intelligence, digital imaging, and computer-assisted navigation. There will likely be many changes and refinements to these technologies over the coming years.

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Cost-effectiveness Applications of Patient-reported Outcome Measures (PROMs) in Spine Surgery

Cited by 18 publications

References 38 publications

The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention

Anterior Cervical Discectomy and Fusion Results in Clinically Significant Improvements in Patients With Preoperative Sleep Difficulties

Robotic Surgical Systems for Orthopedics

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