{Reference Type}: Journal Article
{Title}: What Is the Value Proposition of Evidence-Based Guidelines? An Application of the Operative Value Index for Lumbar Fusions.
{Author}: Sarikonda A;Sami A;Hines K;Self DM;Isch E;Leibold A;Keppetipola KM;Gonzalez G;Mansoor Ali D;Thalheimer S;Heller J;Prasad S;Jallo J;Sharan A;Vaccaro AR;Harrop J;Sivaganesan A;
{Journal}: World Neurosurg
{Volume}: 189
{Issue}: 0
{Year}: 2024 Sep 6
{Factor}: 2.21
{DOI}: 10.1016/j.wneu.2024.07.015
{Abstract}: <B>BACKGROUND: </B>Elective lumbar fusions have received criticism for inappropriate utilization. Here, we use a novel Operative Value Index (OVI) to assess whether "indicated," evidence-based lumbar fusions are associated with increased value (outcomes per dollar spent).<BR><B>METHODS: </B>This study is a retrospective analysis of a prospective observational cohort of 294 patients undergoing elective lumbar fusions at a single large academic institution. All patients were preoperatively evaluated by a panel of neurosurgeons for concordance with evidence-based medicine (EBM), determined through guidelines from the North American Spine Society. Oswestry Disability Index (ODI) scores were collected for all patients both preoperatively and at 6-months postoperatively. Time-driven activity-based costing was employed to determine both direct and indirect intraoperative costs. The OVI was defined as the percent improvement in ODI per $1000 spent intraoperatively. Generalized linear mixed model regression, adjusting for confounders, was performed to assess whether EBM-concordant surgeries were associated with higher OVI.<BR><B>RESULTS: </B>Of 294 elective lumbar fusions, 92.9% (n = 273) were EBM-concordant. The average total cost of an EBM-concordant lumbar fusion was $17,932 (supplies: $13,020; personnel: $4314), compared to $20,616 (supplies: $15,467; personnel: $4758) for an EBM-discordant fusion. Average OVI was 2.27 for a concordant fusion, compared to 0.11 for a discordant fusion. Generalized linear mixed model analysis revealed that EBM-concordant cases were associated with significantly higher OVI (β-coefficient 2.0, P < 0.001).<BR><B>CONCLUSIONS: </B>EBM-concordant fusions were associated with 2% greater improvement in ODI scores from baseline for every $1000 spent intraoperatively. Systematic methods for increasing guideline adherence for lumbar fusions could therefore improve value at scale.