Peter G Passias, Tyler K Williamson, Jordan Lebovic, Andrew Eck, Andrew J Schoenfeld, Claudia Bennett-Caso, Stephane Owusu-Sarpong, Heiko Koller, Lee Tan, Robert Eastlack, Thomas Buell, Renaud Lafage, Virginie Lafage
{"title":"在成人颈椎畸形手术中，坚持最佳调整与提高成本-效用相关。","authors":"Peter G Passias, Tyler K Williamson, Jordan Lebovic, Andrew Eck, Andrew J Schoenfeld, Claudia Bennett-Caso, Stephane Owusu-Sarpong, Heiko Koller, Lee Tan, Robert Eastlack, Thomas Buell, Renaud Lafage, Virginie Lafage","doi":"10.1097/BSD.0000000000001759","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction.</p><p><strong>Objective: </strong>Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility.</p><p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>ACD patients with 2-year data included. Outcomes: distal junctional failure (DJF), good clinical outcome (GCO):[Meeting 2 of 3: (1) NDI>20 or meeting MCID, (2) mJOA≥14, (3)NRS-Neck improved≥2]. Ideal Outcome defined as GCO without DJF or reoperation. Patient groups were stratified by correction to 'Optimal radiographic outcome', defined by cSVA 9 (<40 mm) AND TS-CL (<15 deg) upon correction. Cost calculated by CMS.com definitions, and cost-per-QALY was calculated by converting NDI to SF-6D. Multivariable analysis controlling for age, baseline T1-slope, cSVA, disability, and frailty, was used to assess complication rates, clinical outcomes, and cost-utility based on meeting optimal radiographic outcome.</p><p><strong>Results: </strong>One hundred forty-six patients included: 52 optimal radiographic realignment (O) and 94 not optimal (NO). NO group presented with higher cSVA and T1-slope. Adjusted analysis showed O group suffered similar 90-day complications (P>0.8), but less DJK, DJF (0% vs. 18%; P<0.001) and reoperations (18% vs. 35%; P=0.02). Patients meeting optimal radiographic criteria more often met Ideal outcome [odds ratio: 2.2, (1.1-4.8); P=0.03]. Despite no differences in overall cost, O group saw greater clinical improvement, translating to a better cost-utility [mean difference: $91,000, ($49,000-$132,000); P<0.001].</p><p><strong>Conclusion: </strong>Despite similar perioperative courses, patients optimally realigned experienced less junctional failure, leading to better cost-utility compared with those sub-optimally realigned. 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Outcomes: distal junctional failure (DJF), good clinical outcome (GCO):[Meeting 2 of 3: (1) NDI>20 or meeting MCID, (2) mJOA≥14, (3)NRS-Neck improved≥2]. Ideal Outcome defined as GCO without DJF or reoperation. Patient groups were stratified by correction to 'Optimal radiographic outcome', defined by cSVA 9 (<40 mm) AND TS-CL (<15 deg) upon correction. Cost calculated by CMS.com definitions, and cost-per-QALY was calculated by converting NDI to SF-6D. Multivariable analysis controlling for age, baseline T1-slope, cSVA, disability, and frailty, was used to assess complication rates, clinical outcomes, and cost-utility based on meeting optimal radiographic outcome.</p><p><strong>Results: </strong>One hundred forty-six patients included: 52 optimal radiographic realignment (O) and 94 not optimal (NO). NO group presented with higher cSVA and T1-slope. Adjusted analysis showed O group suffered similar 90-day complications (P>0.8), but less DJK, DJF (0% vs. 18%; P<0.001) and reoperations (18% vs. 35%; P=0.02). Patients meeting optimal radiographic criteria more often met Ideal outcome [odds ratio: 2.2, (1.1-4.8); P=0.03]. Despite no differences in overall cost, O group saw greater clinical improvement, translating to a better cost-utility [mean difference: $91,000, ($49,000-$132,000); P<0.001].</p><p><strong>Conclusion: </strong>Despite similar perioperative courses, patients optimally realigned experienced less junctional failure, leading to better cost-utility compared with those sub-optimally realigned. 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引用次数: 0
摘要
背景：早期并发症可能不能预测成人颈椎畸形（ACD）矫正术后的长期成功。目的：评价最佳复位是否能获得相似的围手术期并发症发生率，并获得长期的成本-效用。研究设计：回顾性队列研究。方法：纳入ACD患者2年资料。结果：远端连接功能衰竭（DJF），良好的临床结果（GCO）：[满足3个中的2个：(1)NDI bb0 20或满足MCID， (2) mJOA≥14,(3)NRS-Neck改善≥2]。理想结果定义为无DJF或再手术的GCO。通过校正cSVA 9定义的“最佳放射学结果”对患者进行分层(结果：146例患者包括：52例最佳放射学调整(O)和94例非最佳放射学调整（NO）。NO组具有较高的cSVA和t1斜率。调整分析显示，O组90天并发症相似（P < 0.05），但DJK、DJF较少(0% vs. 18%；结论：尽管围手术期相似，但与次优化重组患者相比，优化重组患者的结膜功能衰竭较少，成本-效用更好。围手术期并发症的风险不应该排除最佳的手术干预，政策的努力应该更好地关注成人颈椎畸形手术的长期结果。证据等级：三级。
Perseverance of Optimal Realignment is Associated With Improved Cost-utility in Adult Cervical Deformity Surgery.
Background: Early-term complications may not predict long-term success after adult cervical deformity (ACD) correction.
Objective: Evaluate whether optimal realignment results in similar rates of perioperative complications but achieves longer-term cost-utility.
Study design: Retrospective cohort study.
Methods: ACD patients with 2-year data included. Outcomes: distal junctional failure (DJF), good clinical outcome (GCO):[Meeting 2 of 3: (1) NDI>20 or meeting MCID, (2) mJOA≥14, (3)NRS-Neck improved≥2]. Ideal Outcome defined as GCO without DJF or reoperation. Patient groups were stratified by correction to 'Optimal radiographic outcome', defined by cSVA 9 (<40 mm) AND TS-CL (<15 deg) upon correction. Cost calculated by CMS.com definitions, and cost-per-QALY was calculated by converting NDI to SF-6D. Multivariable analysis controlling for age, baseline T1-slope, cSVA, disability, and frailty, was used to assess complication rates, clinical outcomes, and cost-utility based on meeting optimal radiographic outcome.
Results: One hundred forty-six patients included: 52 optimal radiographic realignment (O) and 94 not optimal (NO). NO group presented with higher cSVA and T1-slope. Adjusted analysis showed O group suffered similar 90-day complications (P>0.8), but less DJK, DJF (0% vs. 18%; P<0.001) and reoperations (18% vs. 35%; P=0.02). Patients meeting optimal radiographic criteria more often met Ideal outcome [odds ratio: 2.2, (1.1-4.8); P=0.03]. Despite no differences in overall cost, O group saw greater clinical improvement, translating to a better cost-utility [mean difference: $91,000, ($49,000-$132,000); P<0.001].
Conclusion: Despite similar perioperative courses, patients optimally realigned experienced less junctional failure, leading to better cost-utility compared with those sub-optimally realigned. Perioperative complication risk should not necessarily preclude optimal surgical intervention, and policy efforts might better focus on long-term outcome measures in adult cervical deformity surgery.
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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