Cost-Effectiveness of Single-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylosis

Angevine, Peter D.; Zivin, Joshua Graff; McCormick, Paul C.

doi:10.1097/01.brs.0000176332.67849.ea

Cited by 79 publications

(51 citation statements)

References 74 publications

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“…Long-term follow-up of patients receiving allograft with plating reported clinical and radiological success [111]. Although short-term costs of instrumented allograft compared to non-plating may be expensive, the postoperative period is shorter and 5-year cost-effectiveness similar [4].…”

Section: Mineralized Allograftmentioning

confidence: 99%

Bone graft substitutes in anterior cervical discectomy and fusion

2009

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Anterior cervical discectomy with fusion is a common surgical procedure for patients suffering pain and/ or neurological deficits and unresponsive to conservative management. For decades, autologous bone grafted from the iliac crest has been used as a substrate for cervical arthrodesis. However patient dissatisfaction with donor site morbidity has led to the search for alternative techniques. We present a literature review examining the progress of available grafting options as assessed in human clinical trials, considering allograft-based, synthetic, factor-and cell-based technologies.

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Section: Mineralized Allograftmentioning

confidence: 99%

Bone graft substitutes in anterior cervical discectomy and fusion

2009

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“…Cost analyses of numerous spinal surgical techniques for treating various pathologies permeate the spine literature, ranging from the management of degenerative disc disease to scoliosis deformity. [1][2][3]7,10,11,16,21,[24][25][26][27]30,31,38,39,43 Elucidating the elements that affect the cost of spinal surgery can have significant implications for providing safe care in a cost-effective manner. There is a paucity of studies that directly evaluate the cost of surgery for spinal tumors.…”

mentioning

confidence: 99%

Costs and readmission rates for the resection of primary and metastatic spinal tumors: a comparative analysis of 181 patients

Lau¹,

Chan²,

Theologis

et al. 2016

SPI

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OBJECTIVE Because the surgical strategies for primary and metastatic spinal tumors are different, the respective associated costs and morbidities associated with those treatments likely vary. This study compares the direct costs and 90-day readmission rates between the resection of extradural metastatic and primary spinal tumors. The factors associated with cost and readmission are identified. METHODS Adults (age 18 years or older) who underwent the resection of spinal tumors between 2008 and 2013 were included in the study. Patients with intradural tumors were excluded. The direct costs of index hospitalization and 90-day readmission hospitalization were evaluated. The direct costs were compared between patients who were treated surgically for primary and metastatic spinal tumors. The independent factors associated with costs and readmissions were identified using multivariate analysis. RESULTS A total of 181 patients with spinal tumors were included (63 primary and 118 metastatic tumors). Overall, the mean index hospital admission cost for the surgical management of spinal tumors was $52,083. There was no significant difference in the cost of hospitalization between primary ($55,801) and metastatic ($50,098) tumors (p = 0.426). The independent factors associated with higher cost were male sex (p = 0.032), preoperative inability to ambulate (p = 0.002), having more than 3 comorbidities (p = 0.037), undergoing corpectomy (p = 0.021), instrumentation greater than 7 levels (p < 0.001), combined anterior-posterior approach (p < 0.001), presence of a perioperative complication (p < 0.001), and longer hospital stay (p < 0.001). The perioperative complication rate was 21.0%. Of this cohort, 11.6% of patients were readmitted within 90 days, and the mean hospitalization cost of that readmission was $20,078. Readmission rates after surgical treatment for primary and metastatic tumors were similar (11.1% vs 11.9%, respectively) (p = 0.880). Prior hospital stay greater than 15 days (OR 6.62, p = 0.016) and diagnosis of lung metastasis (OR 52.99, p = 0.007) were independent predictors of readmission. CONCLUSIONS Primary and metastatic spinal tumors are comparable with regard to the direct costs of the index surgical hospitalization and readmission rate within 90 days. The factors independently associated with costs are related to preoperative health status, type and complexity of surgery, and postoperative course.

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“…The probability of a good outcome after reoperation for ASD in the presence and absence of complications was also estimated based on peer-reviewed literature (2,11,16). After reoperation, improvement rates ranging from 51%-100% have been reported (1,3,4,13,17,30). A mean value of 70% was used, and a range from 60%-70% was used in sensitivity analysis.…”

Section: Probabilitiesmentioning

confidence: 99%

“…The probabilities assigned to a particular outcome are often based on systematic reviews of the literature or expert opinion. Although decision trees have been used to analyze various decisions in spinal surgery (1,5,8,10,28,29), they are not a substitute for randomized trials. However, decision analysis can serve as a powerful tool in a setting with incomplete data because a range of values of each specific parameter in the model can be evaluated using the technique of sensitivity analysis.…”

Section: Introductionmentioning

confidence: 99%