Research Fellow NYU Langone Medical Center Paterson, NJ, US
Introduction: Surgical correction of cervical deformity (CD) is a proven treatment option providing functional restoration and pain relief. It is unclear whether patient outcomes and costs of the procedure are influenced by the time between initial symptom onset and definitive surgical intervention
Methods: CD with BL and 2Y data were included. Patients stratified by time to surgery following onset of neck pain: >5 years=Delayed; < 5 years=not Delayed. Normalized HRQL scores at BL and follow-up intervals were generated. Normalized HRQLs plotted and AUC calculated, generating one number describing overall recovery (Integrated Health State[IHS]). Cost calculated using PearlDiver, representing national average Medicare cost. Cost per Quality-Adjusted Life Year (QALY) at 2Y was calculated. Multivariable regression analysis assessed the impact of Delayed surgery on outcomes and cost.
Results: 123 were included (54 Delayed, 69 not Delayed). Demographic and surgical characteristics similar between groups (P>.05). Normalized HRQLs showed Delayed patients exhibit worse NDI and NRS Neck 2Y, P < .05. Additionally, Delayed patients exhibited worse NDI and NRS Neck IHS recovery from 1Y to 2Y, P < .05. Total cost for Delayed patients $56,249 compared to $52,157 not Delayed, P>.05. Utility Gained 2Y was 0.172 for Delayed and 0.2847 for not Delayed. This translated to QALY gained 2Y of 0.334 Delayed and 0.553 not Delayed, P < .05. Cost effectiveness by cost per QALY: Delayed=$96,363 and not Delayed=$58,767, P>.05. Multivariate analysis found Delayed patients were less likely to gain utility (OR 0.125 [CI 0.019-0.840]) and QALYs (OR 0.343 [CI 0.129-0.914]) 2Y, P < .05.
Conclusion : Patients who had 5 year or greater delay to surgery from the onset of neck pain had more significant postoperative neck disability. Cost by procedure and cost effectiveness when stratified by time to surgery following enrollment were comparable. While both patient cohorts had postop improvement, patients without delay had greater utility gained and quality adjusted life years at 2-year follow-up.
