Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology

Chotai, Silky; Sielatycki, John A.; Parker, Scott L.; Sivaganesan, Ahilan; Kay, Harrison F.; Stonko, David P.; Wick, Joseph; McGirt, Matthew J.; Devin, Clinton J.

doi:10.1016/j.spinee.2016.06.023

Cited by 30 publications

(24 citation statements)

References 47 publications

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“…However, these results differ from much of the published literature. 6,9,11,16,17,24 In a study of 1082 patients undergoing ACDF, Minhas et al determined that obesity was associated with a $681 increase in direct hospital costs. 11 Interestingly, these authors found no association between obesity and common cost drivers such as increased hospital stay, complications, or operative time.…”

Section: Discussionmentioning

confidence: 99%

“…5,8 Additionally, previous investigations have revealed that obese patients undergoing spinal fusion incur 27% higher costs than nonobese patients, with ACDF specifically reported to have lower cost-effectiveness in morbidly obese patients. 6,9 Furthermore, concomitant chronic obstructive pulmonary disease and obesity have been correlated with a longer hospital stay and increased hospital charges in women who have undergone ACDF. 17 However, prior investigations have documented no differences in patient-reported outcomes between obese and nonobese patients who have undergone ACDF.…”

mentioning

confidence: 99%

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Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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OBJECTIVEGiven the increasing prevalence of obesity, more patients with a high body mass index (BMI) will require surgical treatment for degenerative spinal disease. In previous investigations of lumbar spine pathology, obesity has been associated with worsened postoperative outcomes and increased costs. However, few studies have examined the association between BMI and postoperative outcomes following anterior cervical discectomy and fusion (ACDF) procedures. Thus, the purpose of this study was to compare surgical outcomes, postoperative narcotics consumption, complications, and hospital costs among BMI stratifications for patients who have undergone primary 1- to 2-level ACDF procedures.METHODSThe authors retrospectively reviewed a prospectively maintained surgical database of patients who had undergone primary 1- to 2-level ACDF for degenerative spinal pathology between 2008 and 2015. Patients were stratified by BMI as follows: normal weight (< 25.0 kg/m2), overweight (25.0–29.9 kg/m2), obese I (30.0–34.9 kg/m2), or obese II–III (≥ 35.0 kg/m2). Differences in patient demographics and preoperative characteristics were compared across the BMI cohorts using 1-way ANOVA or chi-square analysis. Multivariate linear or Poisson regression with robust error variance was used to determine the presence of an association between BMI category and narcotics utilization, improvement in visual analog scale (VAS) scores, incidence of complications, arthrodesis rates, reoperation rates, and hospital costs. Regression analyses were controlled for preoperative demographic and procedural characteristics.RESULTSTwo hundred seventy-seven patients were included in the analysis, of whom 20.9% (n = 58) were normal weight, 37.5% (n = 104) were overweight, 24.9% (n = 69) were obese I, and 16.6% (n = 46) were obese II–III. A higher BMI was associated with an older age (p = 0.049) and increased comorbidity burden (p = 0.001). No differences in sex, smoking status, insurance type, diagnosis, presence of neuropathy, or preoperative VAS pain scores were found among the BMI cohorts (p > 0.05). No significant differences were found among these cohorts as regards operative time, intraoperative blood loss, length of hospital stay, and number of operative levels (p > 0.05). Additionally, no significant differences in postoperative narcotics consumption, VAS score improvement, complication rates, arthrodesis rates, reoperation rates, or total direct costs existed across BMI stratifications (p > 0.05).CONCLUSIONSPatients with a higher BMI demonstrated surgical outcomes, narcotics consumption, and hospital costs comparable to those of patients with a lower BMI. Thus, ACDF procedures are both safe and effective for all patients across the entire BMI spectrum. Patients should be counseled to expect similar rates of postoperative complications and eventual clinical improvement regardless of their BMI.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Narain¹,

Hijji²,

Haws³

et al. 2018

Journal of Neurosurgery: Spine

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“…[59] Utilizing the ACS-NSQIP database, the authors (2014) retrospectively analyzed 30-day postoperative morbidity/mortality rates for morbidly obese patients undergoing anterior/posterior cervical fusions with Class II obesity (35–39.9 kg/m 2 ), and Class III morbid obesity (BMI ≥40 kg/m 2 ). [5] Morbidly obese patients exhibited a greater risk of DVT with anterior fusions, whereas posterior fusions correlated with longer surgical times.…”

Section: No Increased Morbidity For Cervical Spine Surgery In Morbidlmentioning

confidence: 99%

“…The authors, therefore, concluded: “High BMI, regardless of obesity class, does not appear to be associated with increased complications after cervical fusion in the 30-day postoperative period.” Another study (2016) prospectively assessed outcomes for anterior cervical discectomy and fusion (ACDF) in morbidly obese patients. [9] Using the WHO Classification system for Class II (obesity) and Class III (morbid obesity) obesity, at 2 postoperative years, all patients exhibited significant improvement in pain in the Neck Disability Index, and quality of life (QALYs; EuroQol-5D; Short Form-12) scales. They also noted “…no significant difference in post-discharge health-care resource utilization, direct costs, indirect costs, and total costs between obese and non-obese patients…”…”

Section: No Increased Morbidity For Cervical Spine Surgery In Morbidlmentioning

confidence: 99%

More risks and complications for elective spine surgery in morbidly obese patients

Epstein¹

2017

Surg Neurol Int

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Background:The vast majority of studies emphasize the greater morbidity/mortality for elective spine surgery in morbidly obese patients.Methods:This review focuses on the increased morbidity/mortality of performing elective spinal operations in morbidly obese patients. There are two definitions of morbid obesity; a body mass index (BMI) of equal to or greater than 35 plus two major comorbid factors (e.g., hypertension, diabetes, etc.) or a BMI (morbidly obese III) of =≥40 kg/m2.Results:For patients undergoing spinal surgery, morbid obesity increases perioperative morbidity/mortality for various reasons. The quality of preoperative and intraoperative imaging is often compromised potentially leading to mistaken preoperative diagnoses, and wrong level surgery. Resultant major technical surgical limitations include poor/inadequate operative exposure, and the risk of suboptimal placement of instrumentation There is also increased exposure to major perioperative complications such as deep venous thrombosis, pulmonary embolism, infection, pneumonia, cardiac complications, blindness in the prone position, brachial and lumbar plexus injuries, increased anesthetic risks (e.g., even using awake intubation/awake positioning), and postoperative wound seromas/hematomas.Conclusions:Most of the spinal literature documents the marked increased perioperative morbidity/mortality for morbidly obese patients undergoing elective spine surgery. If elective surgery is warranted in these patients, the risks and timing of surgical intervention should include consideration of major preoperative weight loss strategies including bariatric procedures to optimize outcomes.

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“…Even though multiple cost utility or effectiveness analysis studies and reviews have been published over the years in managing spinal pain 33 , 35 , 37 - 53 , there are very few studies assessing the cost utility of non-surgical techniques in managing neck pain 39 , 40 , 50 - 53 . Among the interventional techniques, there are none available for neck pain.…”

Section: Introductionmentioning

confidence: 99%

Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

Manchikanti¹,

Pampati²,

Kaye³

et al. 2017

Int. J. Med. Sci.

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Background:Controlled diagnostic studies have established the prevalence of cervical facet joint pain to range from 36% to 67% based on the criterion standard of ≥ 80% pain relief. Treatment of cervical facet joint pain has been described with Level II evidence of effectiveness for therapeutic facet joint nerve blocks and radiofrequency neurotomy and with no significant evidence for intraarticular injections. However, there have not been any cost effectiveness or cost utility analysis studies performed in managing chronic neck pain with or without headaches with cervical facet joint interventions.Study Design:Cost utility analysis based on the results of a double-blind, randomized, controlled trial of cervical therapeutic medial branch blocks in managing chronic neck pain.Objectives:To assess cost utility of therapeutic cervical medial branch blocks in managing chronic neck pain.Methods: A randomized trial was conducted in a specialty referral private practice interventional pain management center in the United States. This trial assessed the clinical effectiveness of therapeutic cervical medial branch blocks with or without steroids for an established diagnosis of cervical facet joint pain by means of controlled diagnostic blocks. Cost utility analysis was performed with direct payment data for the procedures for a total of 120 patients over a period of 2 years from this trial based on reimbursement rates of 2016. The payment data provided direct procedural costs without inclusion of drug treatments. An additional 40% was added to procedural costs with multiplication of a factor of 1.67 to provide estimated total costs including direct and indirect costs, based on highly regarded surgical literature. Outcome measures included significant improvement defined as at least a 50% improvement with reduction in pain and disability status with a combined 50% or more reduction in pain in Neck Disability Index (NDI) scores.Results:The results showed direct procedural costs per one-year improvement in quality adjusted life year (QALY) of United States Dollar (USD) of $2,552, and overall costs of USD $4,261. Overall, each patient on average received 5.7 ± 2.2 procedures over a period of 2 years. Average significant improvement per procedure was 15.6 ± 12.3 weeks and average significant improvement in 2 years per patient was 86.0 ± 24.6 weeks.Limitations:The limitations of this cost utility analysis are that data are based on a single center evaluation. Only costs of therapeutic interventional procedures and physician visits were included, with extrapolation of indirect costs.Conclusion:The cost utility analysis of therapeutic cervical medial branch blocks in the treatment of chronic neck pain non-responsive to conservative management demonstrated clinical effectiveness and cost utility at USD $4,261 per one year of QALY.

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Effect of obesity on cost per quality-adjusted life years gained following anterior cervical discectomy and fusion in elective degenerative pathology

Cited by 30 publications

References 47 publications

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

Impact of body mass index on surgical outcomes, narcotics consumption, and hospital costs following anterior cervical discectomy and fusion

More risks and complications for elective spine surgery in morbidly obese patients

Cost Utility Analysis of Cervical Therapeutic Medial Branch Blocks in Managing Chronic Neck Pain

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