%0 Journal Article
%T Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions.
%A Kim AH
%A Hostin RA
%A Yeramaneni S
%A Gum JL
%A Nayak P
%A Line BG
%A Bess S
%A Passias PG
%A Hamilton DK
%A Gupta MC
%A Smith JS
%A Lafage R
%A Diebo BG
%A Lafage V
%A Klineberg EO
%A Daniels AH
%A Protopsaltis TS
%A Schwab FJ
%A Shaffrey CI
%A Ames CP
%A Burton DC
%A Kebaish KM
%A  
%J Spine Deform
%V 0
%N 0
%D 2024 Aug 2
%M 39090432
暂无%R 10.1007/s43390-024-00919-7
%X <B>OBJECTIVE: </B>Adult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion.<BR><B>METHODS: </B>ASD patients with > 4-level fusion and 2-year follow-up were included. Index and total episode-of-care costs were estimated using average itemized direct costs obtained from hospital records. Cumulative QALY gained were calculated from preoperative to 2-year postoperative change in Short Form Six-Dimension (SF-6D) scores. The TL and UT groups comprised patients with upper instrumented vertebrae (UIV) at T9-T12 and T2-T5, respectively.<BR><B>RESULTS: </B>Of 566 patients with type N or L curves, mean age was 63.2 ± 12.1 years, 72% were female and 93% Caucasians. Patients in the TL group had better sagittal vertical axis (7.3 ± 6.9 vs. 9.2 ± 8.1 cm, p = 0.01), lower surgical invasiveness (- 30; p < 0.001), and shorter OR time (- 35 min; p = 0.01). Index and total costs were 20% lower in the TL than in the UT group (p < 0.001). Cost/QALY was 65% lower (492,174.6 vs. 963,391.4), and 2-year QALY gain was 40% higher, in the TL than UT group (0.15 vs. 0.10; p = 0.02). Multivariate model showed TL fusions had lower total cost (p = 0.001) and higher QALY gain (p = 0.03) than UT fusions.<BR><B>CONCLUSIONS: </B>In Schwab type N or L curves, TL fusions showed lower 2-year cost and improved QALY gain without increased reoperation rates or length of stay than UT fusions.<BR><B>METHODS: </B>III.