背景:孤立减压和器械融合减压是治疗腰椎滑脱症的公认外科治疗方法。尽管隔离减压是一种成本较低的解决方案,但患者报告的结果相似,与初次融合相比,再手术率较高.
目标:为了确定与初次减压相关的成本,初级融合,减压融合术治疗退行性腰椎滑脱症。我们进一步寻求确定以何种翻修率进行初次减压仍然是一种成本较低的退行性腰椎滑脱手术治疗方法。
方法:对医疗保险提供者分析和审查(MEDPAR)有限数据集的回顾性数据库研究。
方法:接受单级融合或减压治疗退行性腰椎滑脱的患者。
方法:手术护理费用。
方法:从MEDPAR有限数据集中查询2019日历年接受单节段腰椎/腰骶部退行性腰椎滑脱手术的所有住院患者(n=6,653)。患者被分为三组:初级减压(n=300),初次融合(n=5,757),和修订融合(n=566)。进行单变量分析以确定这些组之间的成本差异,并通过多变量回归证实结果。然后进行了经济分析,以确定以何种修订率进行初次减压仍然是成本较低的治疗选择。
结果:关于单变量分析,初次单级减压治疗腰椎滑脱的费用为14,690±9,484美元,初次单级融合的费用为26,376±11,967美元,修正融合的费用为26,686±11,309美元(p<0.001).在多变量分析中,初次融合与3,751美元的费用增加相关,修正融合与7,502美元的费用增加相关(95CI:2,990-4,512,p<0.001).经济分析发现,小于或等于43.8%的翻修率仍将导致所有患者的初次减压手术成本低于初次融合。
结论:孤立减压治疗退行性腰椎滑脱症是一种成本较低的治疗选择,即使翻修融合率高达43.8%。即使在初次融合后假定的0%的翻修率也是如此。这项研究只关注成本数据,然而,而许多患者在适当的指征下仍可从初次融合中获益.
BACKGROUND: 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 re-operation than primary fusion.
OBJECTIVE: 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.
METHODS: A retrospective database study of the Medicare Provider Analysis and Review (MEDPAR) limited data set.
METHODS: Patients who underwent single-level fusion or decompression for degenerative
spondylolisthesis.
METHODS: Cost of surgical care.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.