• Peter G Passias, Avery E Brown, Cole Bortz, Haddy Alas, Katherine Pierce, Waleed Ahmad, Sara Naessig, Renaud Lafage, Virginie Lafage, Hamid Hassanzadeh, Lawal A Labaran, Christopher Ames, Douglas C Burton, Jeffrey Gum, Robert Hart, Richard Hostin, Khaled M Kebaish, Brian J Neuman, Shay Bess, Breton Line, Christopher Shaffrey, Justin Smith, Frank Schwab, Eric Klineberg, and International Spine Study Group.
• Division of Spinal Surgery/Departments of Orthopedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY.
• Spine. 2022 Jan 1; 47 (1): 212621-26.

Study DesignRetrospective study of a prospective multicenter database.ObjectiveThe purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.Summary Of Background DataASD surgery involves complex deformity correction.MethodsInclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.ResultsThree hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3 years was found to be $72,947.87, with no significant difference in costs between deformity groups (P > 0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores <0.19, baseline (BL) SRS Activity >1.5, BL Oswestry Disability Index <50 (all P < 0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores >1.5, age <64, were the top predictors of lower costs (all P < 0.05). Among MSVA patients, ASD invasiveness scores <94.16, no past history of cancer, and frailty scores <0.3 trended toward lower total costs (P = 0.071, P = 0.210). For HSVA, no history of smoking and body mass index <27.8 trended toward lower costs (both P = 0.060).ConclusionASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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