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• W4386041752 abstract "BACKGROUND CONTEXT Prior studies have analyzed the predictive presence of distal junctional kyphosis and failure after adult spinal deformity surgery. However, there remains a gap in the cost utility of DJK and prophylactic efficacy in prevention. PURPOSE To analyze cost efficacy and utility of preoperative prophylaxis in the prevention of DJK occurrence after ACD surgery. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE A total of 360 cervical deformity patients. OUTCOME MEASURES Cost utility, total cost, Quality Adjusted Life Years (QALYs), Complications, DJK METHODS Operative CD patients with 2-year (2Y) data included. Preoperative optimization for osteoporosis was assessed by treatment with an FDA approved drug prior to surgery (OptO). Preoperative rehabilitation (Prehab) was also assessed. Cost analysis was based on average Medicare reimbursement cost while accounting for surgical approach and revision status as well as complications and comorbidities (CC) and major complications and comorbidities (MCC) as defined by CMS.gov manual definitions. Reimbursement consisted of a standardized estimate using regression analysis of Medicare pay-scales for services within a 30-day window. All costs were inflation adjusted to 2022. For QALY analysis, utility was calculated using EQ-5D as previously published. Multivariate regression analysis noted predictive factors to development of DJK related to prophylaxis, adjusting for covariates including age, baseline deformity, and baseline EQ5D. RESULTS A total of 136 met inclusion (57.1±9.5yrs, 60%F, BMI 28.6±6.7kg/m2, CCI: .58±1.0). 24 (22%) developed DJK, with 6 patients (6%) undergoing revision surgery. Multivariate analysis confirmed Prehab patients more likely to improve in ODI (OR .055 [CI .006-.476], p=.008) at 2Y. However, Prehab and no Prehab patients exhibited similar ODI IHS recovery rates from BL to 2Y, P<.05. Total cost for Prehab patients was $59,272 compared to $72,878 for not Prehab, P<.05. Utility Gained at 2Y was 0.168 for Prehab and 0.121 for not Prehab, P<.05. Cost-effectiveness was determined via cost per QALY: Prehab = $14,463 and not Prehab = $45,515, P<.05. For osteoporosis (85.4% Opt), Opt patients had lower odds of 2Y complications (OR: 0.207 [.086, .498],p<.001) and lower TC ($28,053 vs $33,171,p=.002) compared to nonoptimized patients. Average cost of revision surgery due to DJK within 2Y of index surgery was $50,736 ± 31,467, and average cost of index surgery was $44,418. The average cost for patients that developed DJK was $58,620 vs $44,418. The BL NDI was similar for both cohorts (57), however by 2Y, the NDI for DJK patients was (48 vs 37, p=.026) showing a greater improvement in disability for non-DJK patients. When factoring in the improvement and looking at additional cost of QALY by 2Y, the total cost for DJK patients was $89,259 vs $64,973 compared to those optimized preoperatively. CONCLUSIONS The presence of DJK after adult cervical deformity surgery leads to greater surgical cost with lower patient-reported outcomes and greater odds of revision surgery. Although preoperative optimization may increase upfront costs to primary surgery, it presents greater cost utility benefit to prevent the development of DJK and later revision surgery. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Prior studies have analyzed the predictive presence of distal junctional kyphosis and failure after adult spinal deformity surgery. However, there remains a gap in the cost utility of DJK and prophylactic efficacy in prevention. To analyze cost efficacy and utility of preoperative prophylaxis in the prevention of DJK occurrence after ACD surgery. Retrospective cohort. A total of 360 cervical deformity patients. Cost utility, total cost, Quality Adjusted Life Years (QALYs), Complications, DJK Operative CD patients with 2-year (2Y) data included. Preoperative optimization for osteoporosis was assessed by treatment with an FDA approved drug prior to surgery (OptO). Preoperative rehabilitation (Prehab) was also assessed. Cost analysis was based on average Medicare reimbursement cost while accounting for surgical approach and revision status as well as complications and comorbidities (CC) and major complications and comorbidities (MCC) as defined by CMS.gov manual definitions. Reimbursement consisted of a standardized estimate using regression analysis of Medicare pay-scales for services within a 30-day window. All costs were inflation adjusted to 2022. For QALY analysis, utility was calculated using EQ-5D as previously published. Multivariate regression analysis noted predictive factors to development of DJK related to prophylaxis, adjusting for covariates including age, baseline deformity, and baseline EQ5D. A total of 136 met inclusion (57.1±9.5yrs, 60%F, BMI 28.6±6.7kg/m2, CCI: .58±1.0). 24 (22%) developed DJK, with 6 patients (6%) undergoing revision surgery. Multivariate analysis confirmed Prehab patients more likely to improve in ODI (OR .055 [CI .006-.476], p=.008) at 2Y. However, Prehab and no Prehab patients exhibited similar ODI IHS recovery rates from BL to 2Y, P<.05. Total cost for Prehab patients was $59,272 compared to $72,878 for not Prehab, P<.05. Utility Gained at 2Y was 0.168 for Prehab and 0.121 for not Prehab, P<.05. Cost-effectiveness was determined via cost per QALY: Prehab = $14,463 and not Prehab = $45,515, P<.05. For osteoporosis (85.4% Opt), Opt patients had lower odds of 2Y complications (OR: 0.207 [.086, .498],p<.001) and lower TC ($28,053 vs $33,171,p=.002) compared to nonoptimized patients. Average cost of revision surgery due to DJK within 2Y of index surgery was $50,736 ± 31,467, and average cost of index surgery was $44,418. The average cost for patients that developed DJK was $58,620 vs $44,418. The BL NDI was similar for both cohorts (57), however by 2Y, the NDI for DJK patients was (48 vs 37, p=.026) showing a greater improvement in disability for non-DJK patients. When factoring in the improvement and looking at additional cost of QALY by 2Y, the total cost for DJK patients was $89,259 vs $64,973 compared to those optimized preoperatively. The presence of DJK after adult cervical deformity surgery leads to greater surgical cost with lower patient-reported outcomes and greater odds of revision surgery. Although preoperative optimization may increase upfront costs to primary surgery, it presents greater cost utility benefit to prevent the development of DJK and later revision surgery." @default.
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• W4386041752 date "2023-09-01" @default.
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• W4386041752 title "204. Analysis of cost utility of distal junctional kyphosis occurrence after adult cervical deformity surgery: the benefit of prophylaxis and preoperative optimization" @default.
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