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Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions.

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Author information

Affiliations

  • 1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St. 5th Floor, Baltimore, MD, 21205, USA.
      Authors
    • Kim AH 1
    • Kebaish KM 1
    (2 authors)
  • 2. Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA.
      Authors
    • Hostin RA 2
    • Yeramaneni S 2
    • Nayak P 2
    (3 authors)
  • 3. Norton Leatherman Spine Center, Louisville, KY, USA.
      Authors
    • Gum JL 3
    (1 author)
  • 4. Denver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO, USA.
      Authors
    • Line BG 4
    • Bess S 4
    (2 authors)
  • 5. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
      Authors
    • Passias PG 5
    (1 author)
    • Show all (15)

ORCIDs linked to this article

Spine Deformity, 02 Aug 2024, 12(6):1783-1791
https://doi.org/10.1007/s43390-024-00919-7 PMID: 39090432 

Abstract 

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.

Full text links 

Read article at publisher's site: https://doi.org/10.1007/s43390-024-00919-7

References 

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Funding 

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