Should Proximal Fixation Be at C2 or C3-C4? An Application of the Operative Value Index for Elective Posterior Cervical Decompression and Fusion.

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
Advith Sarikonda, D Mitchell Self, Danyal Quraishi, Ashmal Sami, Emily L Isch, Steven Glener, Joshua Heller, Srinivas Prasad, Ashwini Sharan, Jack Jallo, Alexander R Vaccaro, James Harrop, Ahilan Sivaganesan
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引用次数: 0

Abstract

Introduction: There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true "value" (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed.

Methods: We retrospectively identified 275 long-segment (≥ 3-levels fused) PCDFs with available Neck Disability Index (NDI) scores at baseline and at 3-months postoperatively. C2 UIV (n=67) was compared to C3/C4 UIV(n=208). Time-driven activity-based costing (TDABC) was applied to identify the true intraoperative costs for each case. The Operative Value Index (OVI) was defined as the percent improvement in NDI score from baseline, per $1,000 spent intraoperatively. Multivariable regression analysis was performed to compare intraoperative costs and OVI between C2 and C3/C4 UIV.

Results: The average total cost of a C2 construct was $13,751 ($5,247), compared to $10,778 ($2,237) for C3/C4 (p<0.001). 40% of C2 cases and 32% of C3/C4 cases, respectively, achieved clinically significant improvement in NDI. On multivariable regression analysis, C2 UIV was associated with significantly higher total cost (beta-coefficient: $1,814 +/- 553, p=0.001), supply cost (beta-coefficient: $1,185 +/- $482, p=0.015) and personnel cost (beta-coefficient: $275 +/- $116, p=0.019). However, there was no significant difference in OVI (p=0.155) between C2 and C3/C4 UIV.

Conclusions: Although the C2 UIV construct incurred significantly higher intraoperative costs compared to C3/C4 UIV, there was no significant difference in "value" between axial and subaxial UIV.

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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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