在成人脊柱畸形手术中,近端关节后凸和失败预防可在保持最佳对齐的同时提高成本效益。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Peter G Passias, Oscar Krol, Tyler K Williamson, Claudia Bennett-Caso, Justin S Smith, Bassel Diebo, Virginie Lafage, Renaud Lafage, Breton Line, Alan H Daniels, Jeffrey L Gum, Themistocles S Protopsaltis, D Kojo Hamilton, Alex Soroceanu, Justin K Scheer, Robert Eastlack, Gregory M Mundis, Khaled M Kebaish, Richard A Hostin, Munish C Gupta, Han Jo Kim, Eric O Klineberg, Christopher P Ames, Robert A Hart, Douglas C Burton, Frank J Schwab, Christopher I Shaffrey, Shay Bess
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引用次数: 0

摘要

背景和目的:研究在术后对准的背景下,预防技术对近端关节后凸(PJK)和近端关节衰竭(PJF)发展的成本效益和影响。方法:纳入骨盆融合的成人脊柱畸形患者2年的资料。接受PJK预防(钩、系、水泥、微创手术方法)的患者与未接受PJK预防的患者进行比较。这些队列进一步分层为“匹配”和“不匹配”组基于实现年龄调整的对齐标准。使用诊断相关组成本计算成本,包括PJK预防、术后并发症、门诊医疗遭遇、修订和医疗相关再入院。使用转换为SF-6D的Short Form-36计算质量调整寿命年,并使用每年3%的贴现率。控制年龄、性别、融合水平和基线畸形严重程度的多变量分析评估了如果匹配和/或使用PJK预防,发生PJK/PJF的结果。结果:738例成人脊柱畸形患者符合纳入标准(年龄:63.9±9.9,体重指数:28.5±5.7,Charlson合并症指数:2.0±1.7)。多因素分析显示,术后符合年龄调整标准的患者发生PJK或PJF的比例较低(优势比[or]: 0.4, [0.2-0.8];P = .011)。在T1骨盆角度、骨盆发生率腰椎前凸不匹配和骨盆倾斜不匹配的患者中,预防措施降低了发生PJK的可能性(OR: 0.5, [0.3-0.9];P = 0.023)和PJF (OR: 0.1, [0.03-0.5];P = .004)。协方差分析显示,与未进行预防的患者相比,年龄调整队列匹配的患者在2年时具有更好的成本效用(361 539.25美元vs 419 919.43美元;P < 0.001)。年龄调整标准不匹配的患者也产生了更好的成本(88 348.61美元vs 101 318.07美元;P = 0.005)和成本效用(450美元190.80 vs 564美元108.86;P < 0.001)。结论:尽管有额外的手术费用,优化影像学调整结合近端关节预防似乎是一种更具成本效益的策略,主要是因为机械故障导致的再手术最小化。即使在那些没有达到最佳对齐,连接预防措施被证明提高成本效率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Proximal Junctional Kyphosis and Failure Prophylaxis Improves Cost Efficacy, While Maintaining Optimal Alignment, in Adult Spinal Deformity Surgery.

Background and objectives: To investigate the cost-effectiveness and impact of prophylactic techniques on the development of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in the context of postoperative alignment.

Methods: Adult spinal deformity patients with fusion to pelvis and 2-year data were included. Patients receiving PJK prophylaxis (hook, tether, cement, minimally-invasive surgery approach) were compared to those who did not. These cohorts were further stratified into "Matched" and "Unmatched" groups based on achievement of age-adjusted alignment criteria. Costs were calculated using the Diagnosis-Related Group costs accounting for PJK prophylaxis, postoperative complications, outpatient health care encounters, revisions, and medical-related readmissions. Quality-adjusted life years were calculated using Short Form-36 converted to Short-Form Six-Dimension (SF-6D) and used an annual 3% discount rate. Multivariate analysis controlling for age, sex, levels fused, and baseline deformity severity assessed outcomes of developing PJK/PJF if matched and/or with use of PJK prophylaxis.

Results: A total of 738 adult spinal deformity patients met inclusion criteria (age: 63.9 ± 9.9, body mass index: 28.5 ± 5.7, Charlson comorbidity index: 2.0 ± 1.7). Multivariate analysis revealed patients corrected to age-adjusted criteria postoperatively had lower rates of developing PJK or PJF (odds ratio [OR]: 0.4, [0.2-0.8]; P = .011) with the use of prophylaxis. Among those unmatched in T1 pelvic angle, pelvic incidence lumbar lordosis mismatch, and pelvic tilt, prophylaxis reduced the likelihood of developing PJK (OR: 0.5, [0.3-0.9]; P = .023) and PJF (OR: 0.1, [0.03-0.5]; P = .004). Analysis of covariance analysis revealed patients matched in age-adjusted alignment had better cost-utility at 2 years compared with those without prophylaxis ($361 539.25 vs $419 919.43; P < .001). Patients unmatched in age-adjusted criteria also generated better cost ($88 348.61 vs $101 318.07; P = .005) and cost-utility ($450 190.80 vs $564 108.86; P < .001) with use of prophylaxis.

Conclusion: Despite additional surgical cost, the optimization of radiographic realignment in conjunction with prophylaxis of the proximal junction appeared to be a more cost-effective strategy, primarily because of the minimization of reoperations secondary to mechanical failure. Even among those not achieving optimal alignment, junctional prophylactic measures were shown to improve cost efficiency.

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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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