Intrathecal baclofen pump versus combined dorsal/ventral rhizotomy for spastic quadriplegia: healthcare cost and complication analysis.

Abstract

Objective: Combined dorsal/ventral rhizotomy (CDVR) has emerged as a tone management option for pediatric patients with cerebral palsy and medically refractory spasticity. However, its costs to the patient and the healthcare system compared with those of an intrathecal baclofen (ITB) pump are understudied. The authors aimed to evaluate ITB and CDVR with respect to healthcare cost, resource utilization, and clinical safety.

Methods: The records for all pediatric patients who underwent ITB pump placement or CDVR at a single institution between 2003 and 2024 were retrospectively reviewed. Hospital and professional charge data, both inpatient and outpatient, as well as clinical data were collected and analyzed.

Results: Seventeen patients underwent CDVR and 392 underwent ITB therapy. There were no clinically significant differences between the two treatment groups in terms of baseline demographics or Gross Motor Function Classification System level, preoperative risk factors, and comorbidities. None of the patients who had undergone CDVR experienced surgical site infection or CSF leakage, whereas 4.1% of patients in the ITB group had surgical site infection and 1.8% had CSF leakage. There were no differences (p ≥ 0.05) between the treatment groups in terms of mean hospital length of stay (6.5 days) and return to the emergency department or readmission within 30 days, although readmissions were longer in the ITB group (3 vs 0 median days). Accounting for professional and hospital charges for surgery, hospitalization, and follow-up care during the 1st postoperative year, patients in the CDVR group saved a median $7907 relative to those in the ITB group. Over a 10-year period, the projected differential would grow and ITB would ultimately be expected to be 4.6 times more expensive than CDVR, yielding a median cost differential of $182,432 per patient (p < 0.005). Additionally, CDVR, as compared to ITB, required less postoperative follow-up, averaging a projected decrease of 15 clinic visits per patient over 10 years, reducing hospital resource utilization, the burden on caregivers, and indirect costs to families associated with lost wages and transport to and from appointments.

Conclusions: CDVR offers significantly decreased healthcare costs and resource utilization relative to ITB. CDVR has a comparable clinical safety and complication profile and deserves further study as an alternative to ITB.