• Peter G Passias, Waleed Ahmad, Nicholas Kummer, Renaud Lafage, Virginie Lafage, Khaled Kebaish, Alan Daniels, Eric Klineberg, Alex Soroceanu, Jeffrey Gum, Breton Line, Robert Hart, Douglas Burton, Robert Eastlack, Amit Jain, Justin S Smith, Christopher P Ames, Christopher Shaffrey, Frank Schwab, Richard Hostin, Shay Bess, and International Spine Study Group***.
• Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, New York, USA.
• Neurosurgery. 2022 Jan 1; 90 (1): 148153148-153.

BackgroundWith increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation.ObjectiveTo investigate costs associated with ASD and frailty.MethodsPatients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated.ResultsFive hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149).ConclusionDespite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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