Nayak Pratibha, Hostin Richard, Gum Jeffrey L, Line Breton, Bess Shay, Lenke Lawrence G, Lafage Renaud, Smith Justin S, Diebo Bassel, Lafage Virginie, Klineberg Eric, Kim Han Jo, Passias Peter, Kebaish Khal, Eastlack Robert, Daniels Alan H, Mundis Gregory M, Protopsaltis Themistocles S, Hamilton D Kojo, Gupta Munish, Schwab Frank J, Shaffrey Christopher I, Ames Christopher P
HCA Research Institute, Center for Outcomes Research Medical City Dallas, Dallas, TX, USA.
Department of Orthopedic Surgery, Medical City Dallas, 12222 N Central Expy, Suite 420, Dallas, TX, 75243, USA.
Spine Deform. 2025 Sep 6. doi: 10.1007/s43390-025-01167-z.
A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.
This prospective, multicenter study analyzed data from ASD patients with > 4 levels of spinal fusion and a minimum 2-year follow-up. Index and total episode-of-care (EOC) costs in 2022 US dollars were calculated using average itemized direct costs obtained from administrative hospital records. Patients with total 2-year EOC cost > 90th percentile were considered super-utilizers, the characteristics of which we identified through a multivariate generalized logistic model.
Of 1299 eligible patients, mean age was 60 years, 73% were female and 92% were Caucasian. Super-utilizers were older (+2.1 years; p = 0.012), had greater depression (34.2 vs 25.7%; p = 0.03), increased frailty (p = 0.009) comorbidities (p = 0.005), higher reoperation rates (54.4 vs 15.0%; p < 0.001), hospital length of stay (+ 3 days; p < 0.0001), higher surgical invasiveness (+28.6; p < 0.001), more vertebrae fused (+ 3; p < 0.0001); interbody fusions (80 vs 55%; p < 0.0001), bone morphogenetic protein (BMP) use (87.3 vs 69.4%; p = 0.0001), operative time (+91 min; p < 0.0001), and blood loss (+620 mL; p < 0.0001) compared to other ASD patients. Index cost was 65% (p < 0.0001), and cost/quality-adjusted life-year was three times higher among super-utilizers.
ASD patients with depression who undergo more complex or revision spinal surgical procedures are more likely to be super-utilizers. Identifying likely super-utilizers within the ASD population may enable targeted interventions and preoperative planning to reduce unnecessary costs, while improving patient outcomes.
接受矫正手术的一部分成人脊柱畸形（ASD）患者消耗了不成比例的医疗资源，产生了更高的费用。我们研究了ASD患者中这类医疗资源过度使用者的特征。
这项前瞻性、多中心研究分析了脊柱融合超过4节且至少随访2年的ASD患者的数据。2022年美元的索引费用和总护理期间（EOC）费用使用从医院行政记录中获得的平均逐项直接费用进行计算。2年EOC总费用超过第90百分位数的患者被视为过度使用者，我们通过多变量广义逻辑模型确定了其特征。
在1299名符合条件的患者中，平均年龄为60岁，73%为女性，92%为白种人。与其他ASD患者相比，过度使用者年龄更大（+2.1岁；p = 0.012），抑郁程度更高（34.2%对25.7%；p = 0.03），虚弱增加（p = 0.009），合并症更多（p = 0.005），再次手术率更高（54.4%对15.0%；p < 0.001），住院时间更长（+3天；p < 0.0001），手术侵袭性更高（+28.6；p < 0.001），融合的椎体更多（+3；p < 0.000）；椎间融合（80%对55%；p < 0.0001），使用骨形态发生蛋白（BMP）的比例更高（87.3%对69.4%；p = 0.0001），手术时间更长（+91分钟；p < 0.0001），失血量更多（+620毫升；p < 0.0001）。索引费用高出65%（p < 0.0001），过度使用者的费用/质量调整生命年高出三倍。
患有抑郁症且接受更复杂或翻修脊柱手术的ASD患者更有可能成为过度使用者。识别ASD人群中可能的过度使用者可能有助于进行有针对性的干预和术前规划，以降低不必要的费用，同时改善患者预后。
