Spine Surgeon NYU School of Medicine New Canaan, CT, US
Introduction: Operative Adult Spinal Deformity(ASD) patients are particularly vulnerable to the deleterious impact of comorbidities, thus preoperative optimization of modifiable health factors may improve surgical outcomes and cost effectiveness. This study aims to assess impact of pre-operative optimization of modifiable health conditions on perioperative complications and operative costs in patients undergoing surgical correction of ASD.
Methods: Retrospective analysis of a single-center ASD database. Patients with perioperative data were included. Optimization of diabetes(DM), osteoporosis, and nutritional status was assessed. Patients with DM were considered optimized(Opt) if pre-op HbA1c≤7%. Those with osteoporosis were Opt if treated with an FDA approved drug prior to surgery. Nutritional status was assessed by ranking patients into quartiles(Q1-Q4) by BMI. Q1(low) and Q4(high) were considered N-Opt. Total Costs(TC) were calculated from average Medicare DRG reimbursement. Where applicable, pre-op(≤90days) costs incurred directly related to optimization(e.g. drugs) were added to TC. Multivariable analyses assessed perioperative outcomes while accounting covariates.
Results: 269 patients were included(24.2% DM; 15.2% osteoporotic). Of diabetics(70.8% Opt), Opt patients had lower odds of wound infection(OR: 0.059 [0.007,0.491],p=.009) and 90-day readmission(OR: 0.107 [0.033,0.352],p < .001). Accordingly, Opt patients had significantly lower TC($27,385 vs. $35,955,p < .001). For osteoporosis(85.4% Opt), Opt patients had lower odds of peri-op complications(OR: 0.207 [0.086,0.498],p < .001) and lower TC($28,053 vs. $33,171,p=.002). For nutritional status(50.2% Opt), mean BMI of N-Op quartiles were 21.4 kg/m2(Q1) and 39.1 kg/m2(Q4). Compared to N-Opt quartiles, odds of peri-op complications were lower for patients in Q2(OR: 0.354 [0.200,0.625],p < .001) and Q3(OR: 0:380 [0.193,0.751],p=.005). TC were significantly lower in Opt quartiles(p < .001).
Conclusion : Despite accounting for surgical differences and costs of preoperative interventions, total costs were significantly lower in optimized patients. Thus, optimizing modifiable health conditions preoperatively may benefit ASD patients by reducing perioperative complications while also minimizing utilization of hospital resources and lowing total costs.
