Hospital for Special Surgery, New York, NY, USA.
Hospital for Special Surgery, New York, NY, USA.
Spine J. 2024 Sep;24(9):1690-1696. doi: 10.1016/j.spinee.2024.05.004. Epub 2024 Jun 5.
Isolated decompression and decompression with instrumented fusion are accepted surgical treatments for lumbar spondylolisthesis. Although isolated decompression is a less costly solution with similar patient-reported outcomes, it is associated with higher rates of reoperation than primary fusion.
To determine the costs associated with primary decompression, primary fusion, and decompression and fusion for degenerative spondylolisthesis. We further sought to establish at what revision rate is primary decompression still a less costly surgical treatment for degenerative lumbar spondylolisthesis.
STUDY DESIGN/SETTING: A retrospective database study of the Medicare Provider Analysis and Review (MEDPAR) limited data set.
Patients who underwent single-level fusion or decompression for degenerative spondylolisthesis.
Cost of surgical care.
All inpatient stays that underwent surgery for single-level lumbar/lumbosacral degenerative spondylolisthesis in the 2019 calendar year (n=6,653) were queried from the MEDPAR limited data set. Patients were stratified into three cohorts: primary decompression (n=300), primary fusion (n=5,757), and revision fusion (n=566). Univariate analysis was conducted to determine cost differences between these groups and results were confirmed with multivariable regression. An economic analysis was then done to determine at what revision rate would primary decompression still be a less costly treatment choice.
on univariate analysis, the cost of primary single-level decompression for spondylolisthesis was $14,690±9,484, the cost of primary single-level fusion was $26,376±11,967, and revision fusion was $26,686±11,309 (p<0.001). on multivariate analysis, primary fusion was associated with an increased cost of $3,751, and revision fusion was associated with increased cost of $7,502 (95%ci: 2,990-4,512, p<0.001). economic analysis found that a revision rate less than or equal to 43.8% would still result in primary decompression being less costly for a practice than primary fusion for all patients.
Isolated decompression for degenerative lumbar spondylolisthesis is a less costly treatment choice even with rates of revision fusion as high as 43.8%. This was true even with an assumed revision rate of 0% after primary fusion. This study solely looks at cost data, however, and many patients may still benefit from primary fusion when appropriately indicated.
对于腰椎滑脱症，单纯减压和减压加内固定融合术都是可接受的手术治疗方法。虽然单纯减压的费用较低，患者报告的结果也相似，但它与更高的再手术率有关。
确定原发性减压、原发性融合以及减压融合治疗退行性腰椎滑脱的相关成本。我们还试图确定，在多大的再手术率下，原发性减压仍然是退行性腰椎滑脱的一种成本较低的手术治疗方法。
研究设计/设置：对 Medicare Provider Analysis and Review（MEDPAR）有限数据集的回顾性数据库研究。
接受单节段融合或减压治疗退行性腰椎滑脱的患者。
手术治疗的成本。
从 MEDPAR 有限数据集查询了 2019 年日历年度接受单节段腰椎/腰骶段退行性腰椎滑脱手术的所有住院患者（n=6653）。患者分为三组：原发性减压（n=300）、原发性融合（n=5757）和修正融合（n=566）。进行单变量分析以确定这些组之间的成本差异，结果通过多变量回归得到确认。然后进行经济分析，以确定在多大的再手术率下，原发性减压仍然是一种成本较低的治疗选择。
单变量分析显示，原发性单节段减压治疗腰椎滑脱的费用为 14690±9484 美元，原发性单节段融合的费用为 26376±11967 美元，修正融合的费用为 26686±11309 美元（p<0.001）。多变量分析显示，原发性融合与成本增加 3751 美元相关，修正融合与成本增加 7502 美元相关（95%置信区间：2990-4512，p<0.001）。经济分析发现，对于所有患者来说，即使修正融合的再手术率高达 43.8%，原发性减压的费用仍低于原发性融合。这在原发性融合的假设再手术率为 0%时也是如此。本研究仅关注成本数据，但是，许多患者在适当的情况下仍可能受益于原发性融合。
