• Peter G Passias, Nicholas A Kummer, Tyler K Williamson, Waleed Ahmad, Jordan Lebovic, Virginie Lafage, Renaud Lafage, Han Jo Kim, Alan H Daniels, Jeffrey L Gum, Bassel G Diebo, Munish C Gupta, Alexandra Soroceanu, Justin K Scheer, D Kojo Hamilton, Eric O Klineberg, Breton Line, Andrew J Schoenfeld, Robert A Hart, Douglas C Burton, Robert K Eastlack, Gregory M Mundis, Praveen Mummaneni, Dean Chou, Paul Park, Frank J Schwab, Christopher I Shaffrey, Shay Bess, Christopher P Ames, Justin S Smith, and International Spine Study Group.
• Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY.
• Spine. 2022 Oct 15; 47 (20): 1418-1425.

Summary Of Background DataThe influence of frailty on economic burden following corrective surgery for the adult cervical deformity (CD) is understudied and may provide valuable insights for preoperative planning.ObjectiveTo assess the influence of baseline frailty status on the economic burden of CD surgery.Study DesignRetrospective cohort.Materials And MethodsCD patients with frailty scores and baseline and two-year Neck Disability Index data were included. Frailty score was categorized patients by modified CD frailty index into not frail (NF) and frail (F). Analysis of covariance was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline sacral slope, T1 slope minus cervical lordosis, C2-C7 angle, C2-C7 sagittal vertical axis. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare payscales for services within a 30-day window including length of stay and death. This data is representative of the national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per quality-adjusted life-year (QALY) at two years was calculated for NF and F patients.ResultsThere were 126 patients included. There were 68 NF patients and 58 classified as F. Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P >0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P =0.793), resulting in equivocal costs per QALYs for both patients at two years ($90,113.79 vs. $80,866.66, P =0.097).ConclusionF and NF patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to comparative cost-effectiveness with NF patients based on cost per QALYs at two years. Surgical correction for CD is an economical healthcare investment for F patients when accounting for anticipated utility gained and cost-effectiveness following the procedure.Level Of EvidenceIII.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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