PDF(Pubmed)
Abstract：
UNASSIGNED: The rise in degenerative lumbar spondylolisthesis (DLS) cases has led to a significant increase in fusion surgeries, which incur substantial hospitalization costs and often necessitate chronic opioid use for pain management. Recent evidence suggests that single-level low-grade DLS outcomes are comparable whether a fusion procedure or decompression alone is performed, sparking debate over the cost-effectiveness of these procedures, particularly with the advent of minimally invasive techniques reducing the morbidity of fusion. This study aims to compare chronic opioid utilization and associated costs between decompression alone and decompression with instrumented fusion for single-level degenerative lumbar spondylolisthesis.
UNASSIGNED: Using data from the PearlDiver database, a retrospective database analysis was conducted. We analyzed records of Medicare and Medicaid patients undergoing lumbar fusion or decompression from 2010 to 2022. Patient cohorts were divided into decompression alone (DA) and decompression with instrumented fusion (DIF). Chronic opioid use, pain clinic visits, and total costs were compared between the two groups at 90 days, 1 year, and 2 years post-surgery.
UNASSIGNED: Does DIF offer a more cost-effective approach to managing DLS in terms of chronic opioid use in single-level DLS patients.
UNASSIGNED: The study revealed comparable chronic opioid use and pain clinic visits between DA and DIF groups at 90 days and 1 year. However, total costs associated with opioid prescriptions as well as surgical aftercare were significantly higher in the DIF group at 90 days (p < 0.05), 1 year (p < 0.05), and 2 years (p < 0.05) post-surgery compared to the DA group.
UNASSIGNED: This study highlights the higher costs associated with DIF up to 2 years post-surgery despite comparable symptom improvement when compared to DA and DIF at the 1-year interval. DA emerges as a more financially favorable option, challenging the notion of fusion\'s cost-offsetting benefits. While further investigation is needed to understand underlying cost drivers and optimize outcomes, our findings emphasize the necessity of integrating clinical and economic factors in the management of single-level DLS.
UNASSIGNED: Using data from the PearlDiver database, a retrospective database analysis was conducted. We analyzed records of Medicare and Medicaid patients undergoing lumbar fusion or decompression from 2010 to 2022. Patient cohorts were divided into decompression alone (DA) and decompression with instrumented fusion (DIF). Chronic opioid use, pain clinic visits, and total costs were compared between the two groups at 90 days, 1 year, and 2 years post-surgery.
UNASSIGNED: Does DIF offer a more cost-effective approach to managing DLS in terms of chronic opioid use in single-level DLS patients.
UNASSIGNED: The study revealed comparable chronic opioid use and pain clinic visits between DA and DIF groups at 90 days and 1 year. However, total costs associated with opioid prescriptions as well as surgical aftercare were significantly higher in the DIF group at 90 days (p < 0.05), 1 year (p < 0.05), and 2 years (p < 0.05) post-surgery compared to the DA group.
UNASSIGNED: This study highlights the higher costs associated with DIF up to 2 years post-surgery despite comparable symptom improvement when compared to DA and DIF at the 1-year interval. DA emerges as a more financially favorable option, challenging the notion of fusion\'s cost-offsetting benefits. While further investigation is needed to understand underlying cost drivers and optimize outcomes, our findings emphasize the necessity of integrating clinical and economic factors in the management of single-level DLS.
摘要：
■退行性腰椎滑脱（DLS）病例的增加导致了融合手术的显着增加，这会导致大量的住院费用，并且通常需要长期使用阿片类药物来进行疼痛管理。最近的证据表明，无论是进行融合程序还是单独进行减压，单级别低等级DLS结果都具有可比性。引发了关于这些程序的成本效益的辩论，特别是随着微创技术的出现，降低了融合的发病率。这项研究旨在比较单纯减压和器械融合减压治疗单水平退行性腰椎滑脱的慢性阿片类药物利用和相关成本。
■使用PearlDiver数据库中的数据，进行了回顾性数据库分析.我们分析了2010年至2022年接受腰椎融合或减压的Medicare和Medicaid患者的记录。患者队列分为单独减压（DA）和器械融合减压（DIF）。长期使用阿片类药物，疼痛诊所就诊，比较两组90天的总费用，1年,术后2年.
■DIF是否提供了一种更具成本效益的方法来管理单水平DLS患者的长期阿片类药物使用。
该研究显示，在90天和1年时，DA和DIF组之间的慢性阿片类药物使用和疼痛门诊就诊具有可比性。然而,与阿片类药物处方以及手术后护理相关的总费用在90天时DIF组明显更高(p<0.05)，1年（p<0.05），与DA组相比，术后2年（p<0.05）。
■这项研究强调了与DIF相关的更高成本，尽管与1年间隔的DA和DIF相比，症状改善相当。DA成为一种财务上更有利的选择，挑战融合成本抵消收益的概念。虽然需要进一步调查以了解潜在的成本动因并优化结果，我们的研究结果强调了在单水平DLS管理中整合临床和经济因素的必要性.
■使用PearlDiver数据库中的数据，进行了回顾性数据库分析.我们分析了2010年至2022年接受腰椎融合或减压的Medicare和Medicaid患者的记录。患者队列分为单独减压（DA）和器械融合减压（DIF）。长期使用阿片类药物，疼痛诊所就诊，比较两组90天的总费用，1年,术后2年.
■DIF是否提供了一种更具成本效益的方法来管理单水平DLS患者的长期阿片类药物使用。
该研究显示，在90天和1年时，DA和DIF组之间的慢性阿片类药物使用和疼痛门诊就诊具有可比性。然而,与阿片类药物处方以及手术后护理相关的总费用在90天时DIF组明显更高(p<0.05)，1年（p<0.05），与DA组相比，术后2年（p<0.05）。
■这项研究强调了与DIF相关的更高成本，尽管与1年间隔的DA和DIF相比，症状改善相当。DA成为一种财务上更有利的选择，挑战融合成本抵消收益的概念。虽然需要进一步调查以了解潜在的成本动因并优化结果，我们的研究结果强调了在单水平DLS管理中整合临床和经济因素的必要性.
