Institute for Health Care Research and Improvement, Baylor Health Care System, 8080 N. Central Expy, Suite 500, Dallas, TX 75206, USA; Department of Economics, Southern Methodist University, PO Box 750235, Dallas, TX 75275, USA.
Spine J. 2013 Dec;13(12):1843-8. doi: 10.1016/j.spinee.2013.06.048.
Existing literature on adult spinal deformity (ASD) offers little guidance regarding an evidence-based approach to care. To optimize the value of medical treatment, a thorough understanding of the cost of surgical treatment for ASD is required.
To evaluate four clinically and radiographically distinct groups of ASD and identify and compare the cost of surgical treatment among the groups.
STUDY DESIGN/SETTING: Multicenter retrospective study of consecutive surgeries for ASD.
Three hundred twenty-five consecutive ASD patients treated between 2008 and 2010.
Cost data were collected from hospital administrative records on the direct costs (DCs) incurred for the episode of surgical care, excluding overhead.
Based on preoperative radiographs and history, patients were categorized into one of four diagnostic categories of deformity: primary idiopathic scoliosis (PIS), primary degenerative scoliosis (PDS), primary sagittal plane deformity (PSPD), and revision (R). Analysis of variance and generalized linear model regressions were used to analyze the DCs of surgery and to assess differences in costs across the four diagnostic categories considered.
Significant differences were observed in DC of surgery for different categories of ASD, with surgical treatment for PDS the most expensive followed in decreasing order by PSPD, PIS, and R (p<.01). Results further revealed a significant positive relationship between age and DC (p<.01) and a significant positive relationship between length of stay and DC (p<.01). Among PIS patients, for every incremental increase in levels fused, the expected DC increased by $3,997 (p=.00). Fusion to pelvis also significantly increased the DC of surgery for patients aged 18 to 29 years (p<.01) and 30 to 59 years (p<.01) but not for 60 years or more (p=.86).
There is an increasing DC of surgery with increasing age, length of hospital stay, length of fusion, and fusions to the pelvis. Revision surgery is the least expensive surgery on average and should therefore not preclude its consideration from a pure cost perspective.
现有的成人脊柱畸形（ASD）文献几乎没有提供循证护理方法的指导。为了优化医疗治疗的价值，需要全面了解 ASD 手术治疗的成本。
评估四种临床和影像学上不同的 ASD 分组，并确定和比较各组的手术治疗成本。
研究设计/设置：对 ASD 连续手术的多中心回顾性研究。
2008 年至 2010 年间治疗的 325 例连续 ASD 患者。
从医院行政记录中收集手术治疗期间直接成本（DCs）的成本数据，不包括间接成本。
根据术前 X 光片和病史，患者被归类为以下四种畸形诊断类别之一：原发性特发性脊柱侧凸（PIS）、原发性退行性脊柱侧凸（PDS）、原发性矢状面畸形（PSPD）和翻修（R）。方差分析和广义线性模型回归用于分析手术的 DC，并评估考虑的四个诊断类别之间的成本差异。
不同 ASD 类别之间的手术 DC 存在显著差异，PDS 的手术治疗费用最高，其次是 PSPD、PIS 和 R（p<.01）。结果还进一步显示年龄与 DC 之间存在显著正相关关系（p<.01），住院时间与 DC 之间存在显著正相关关系（p<.01）。在 PIS 患者中，每增加一个融合的节段，预期 DC 增加 3997 美元（p=.00）。融合至骨盆也显著增加了 18 至 29 岁（p<.01）和 30 至 59 岁（p<.01）患者的手术 DC，但对 60 岁或以上患者则无显著影响（p=.86）。
随着年龄、住院时间、融合长度和骨盆融合的增加，手术 DC 也随之增加。翻修手术平均而言是最便宜的手术，因此从纯粹的成本角度考虑不应排除其可能性。
