成人脊柱畸形手术后近端交界性失败翻修手术的经济影响：一家大型畸形中心10年经验中57例手术的成本分析
Economic Impact of Revision Surgery for Proximal Junctional Failure After Adult Spinal Deformity Surgery: A Cost Analysis of 57 Operations in a 10-year Experience at a Major Deformity Center.
作者信息
Theologis Alexander A, Miller Liane, Callahan Matt, Lau Darryl, Zygourakis Corinna, Scheer Justin K, Burch Shane, Pekmezci Murat, Chou Dean, Tay Bobby, Mummaneni Praveen, Berven Sigurd, Deviren Vedat, Ames Christopher P
机构信息
Department of Orthopedic Surgery, University of California-San Francisco, San Francisco, CA.
Department of Neurological Surgery, University of California-San Francisco, San Francisco, CA.
出版信息
Spine (Phila Pa 1976). 2016 Aug 15;41(16):E964-E972. doi: 10.1097/BRS.0000000000001523.
STUDY DESIGN
Retrospective cohort analysis.
OBJECTIVE
To evaluate the economic impact of revision surgery for proximal junctional failures (PJF) after thoracolumbar fusions for adult spinal deformity (ASD).
SUMMARY OF BACKGROUND DATA
PJF after fusions for ASD is a major cause of disability. Although clinical sequelae are described, PJF-revision operation costs are incompletely defined.
METHODS
Consecutive adults who underwent thoracolumbar fusions for ASD (August, 2003 to January, 2013) were evaluated. Inclusion criteria include construct from pelvis to L2 or above and minimum 6 months follow-up after the index ASD operation. Direct costs (surgical supplies/implants, room/care, pharmacy, services) were identified from medical billing data and calculated for index ASD operations and subsequent surgeries for PJF. Not included in direct cost data were indirect costs, charges, surgeon fees, or revision operations for indications other than PJF (i.e., pseudarthrosis). Patients were compared based on the construct's upper-instrumented vertebra: upper thoracic (UT: T1-6) versus thoracolumbar junction (TLjxn: T9-L2).
RESULTS
Of 501 patients, 382 met inclusion criteria. Fifty-one patients [UT:14; TLjxn: 40 at index; average follow-up 32.6 months (6-92 months)] had revisions for PJF, which summed to $3.2 million total direct cost. Average direct cost of index operations for the cohort ($68,294) was significantly greater than PJF-revisions ($55,547). Compared with TLjxn, UT had a significantly higher average cost for index operations ($79,860 vs. $65,868). However, PJF-revision cases were similar in average cost (UT:$60,103; TLjxn:$53,920; P = 0.09). Costs of PJF amounted to an additional 12.1% of the total index surgical cost in 382 patients.
CONCLUSION
Revision operations for PJF after long thoracolumbar fusions for ASD are associated with an average direct cost of $55,547 per case. Revision costs for PJF are similar based on the index procedure's upper-instrumented vertebra level. At a major tertiary center over a 10-year period, PJF came at a very significant economic expense amounting to $3.2 million for 57 cases.
LEVEL OF EVIDENCE
研究设计
回顾性队列分析。
目的
评估成人脊柱畸形（ASD）胸腰椎融合术后近端交界性失败（PJF）翻修手术的经济影响。
背景数据总结
ASD融合术后的PJF是致残的主要原因。尽管已描述了临床后遗症，但PJF翻修手术的费用尚未完全明确。
方法
对2003年8月至2013年1月期间接受ASD胸腰椎融合术的连续成年患者进行评估。纳入标准包括从骨盆至L2或以上的内固定结构以及初次ASD手术后至少6个月的随访。直接费用（手术耗材/植入物、病房/护理、药房、服务）从医疗计费数据中确定，并计算初次ASD手术及随后PJF翻修手术的费用。直接费用数据中未包括间接费用、收费、外科医生费用或PJF以外适应症（即假关节）的翻修手术费用。根据内固定结构的上位固定椎体对患者进行比较：上胸椎（UT：T1 - 6）与胸腰段交界（TLjxn：T9 - L2）。
结果
501例患者中，382例符合纳入标准。51例患者[UT：14例；初次手术时TLjxn：40例；平均随访32.6个月（6 - 92个月）]因PJF进行了翻修，直接费用总计320万美元。该队列初次手术的平均直接费用（68,294美元）显著高于PJF翻修手术（55,547美元）。与TLjxn相比，UT初次手术的平均费用显著更高（79,860美元对65,868美元）。然而，PJF翻修病例的平均费用相似（UT：60,103美元；TLjxn：53,920美元；P = 0.09）。在382例患者中，PJF的费用占初次手术总费用的12.1%。
结论
ASD长节段胸腰椎融合术后PJF的翻修手术平均每例直接费用为55,547美元。根据初次手术的上位固定椎体水平，PJF的翻修费用相似。在一个大型三级中心的10年期间，57例PJF病例的经济费用非常高，达320万美元。
证据级别
3级。
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