The Additional Economic Burden of Frailty in Adult Cervical Deformity Patients Undergoing Surgical Intervention.

Overview

abstract

SUMMARY OF BACKGROUND DATA: The influence of frailty on economic burden following corrective surgery for adult cervical deformity (CD) is understudied and may provide valuable insights for pre-operative planning. OBJECTIVE: To assess the influence of baseline frailty status on the economic burden of CD surgery. STUDY DESIGN: Retrospective cohort. METHODS: CD patients with frailty scores and baseline (BL) and 2-year (2Y) NDI data were included. Frailty score was categorized patients by mFI-CD into Not Frail (NF) and Frail (F). ANCOVA was used to estimate marginal means adjusting for age, sex, surgical approach, and baseline Sacral Slope, TS-CL, C2-C7 angle, cSVA. Costs were derived from PearlDiver registry data. Reimbursement consisted of a standardized estimate using regression analysis of Medicare pay-scales for services within a 30-day window including length of stay and death. This data is representative of national average Medicare cost differentiated by complication/comorbidity outcome, surgical approach, and revision status. Cost per Quality-Adjusted Life Year (QALY) at 2Y was calculated for NF and F patients. RESULTS: There were 126 patients included. There were 68 Not Frail patients and 58 classified as Frail (F). Frailty groups did not differ by overall complications, instance of distal junctional kyphosis, or reoperations (all P>0.05). These groups had similar rates of radiographic and clinical improvement by two years. NF and F had similar overall cost ($36,731.03 vs. $37,356.75, P=0.793), resulting in equivocal costs per QALYs for both patients at 2Y ($90,113.79 vs. $80,866.66, P=0.097). CONCLUSION: Frail and not frail patients experienced similar complication rates and upfront costs, with equivocal utility gained, leading to a comparative cost effectiveness with non-frail patients based on cost per QALYs at two years. Surgical correction for cervical deformity is an economical healthcare investment for frail patients, when accounting for anticipated utility gained and cost-effectiveness following the procedure. LEVEL OF EVIDENCE: III.