Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management
Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management
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DOI：
10.1097/brs.0000000000001626
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发表时间：
2018-03-01
期刊：
影响因子：
3
通讯作者：
Ames, Christopher P.
中科院分区：
文献类型：
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作者：
Scheer, Justin K.;Hostin, Richard;Ames, Christopher P.
研究设计。前瞻性多中心成人脊柱畸形（ASD）数据库的回顾性分析。比较ASD患者手术与非手术治疗的质量调整生命年（QALYs）。背景资料摘要。与非手术治疗相比，ASD的手术治疗反复显示其HRQOL的改善。然而，关于asd手术矫正后质量改善的报道很少。纳入标准：>= 18岁，ASD。根据SF6D评分计算健康效用值，并用于计算基线效用值至少2年的QALYs，以及可用患者的1、2和3年的QALYs。使用六个基线变量进行1:1倾向评分匹配，以解释手术和非手术治疗的非随机分布。纳入479例患者（OP: 258, 70.7%, NONOP:221, 47.1%）。151例（OP:90, NONOP:61）有完整的1、2和3年的QALY趋势数据。摘要中没有列出不匹配的结果。配对组的平均基线疗效评分在统计学上相似（OP:0.609 +/- 0.093, NONOP: 0.600 +/- 0.091, P = 0.6401），术后2年的平均OP QALY大于NONOP（分别为1.377 +/- 0.345比1.256 +/- 0.286,P < 0.01）。对于亚分析队列，术后1年、2年和3年的平均OP QALYs均显著大于NONOP， P < 0.03（1年：0.651 +/- 0.089 vs. 0.61 +/- 0.079, 2年：1.29 +/- 0.157 vs. 1.189垂直于0.141,3年：1.903 +/- 0.235 vs. 1.749垂直于0.198）。匹配的OP在术后至少2年的QALYs（从基线）获得更大（0.112 +/- 0.243 vs. 0.008 +/- 0.195, P < 0.01）。对于具有完整1 - 3年数据的患者的亚分析，OP在1年、2年和3年获得的QALYs明显大于NONOP: 1年（0.073 +/- 0.121 vs. 0.029 +/- 0.082, P = 0.0447）、2年（0.167 +/- 0.232 vs. 0.036 +/- 0.173, P = 0.0030）和3年（0.238 +/- 0.379 vs. 0.059 +/- 0.258, P < 0.01）。与非手术治疗相比，手术治疗成人脊柱畸形的平均QALYs和术后至少2年以及1年、2年和3年时间点的QALYs明显更高。
Study Design. Retrospective review of prospective multicenter adult spinal deformity (ASD) database.Objective. To compare the quality-adjusted life years (QALYs) between operative and nonoperative treatments for ASD patients.Summary of Background Data. Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding QALY improvements after surgical correction of ASD.Methods. Inclusion criteria: >= 18 years, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs at minimum 2 years from the baseline utility value as well as at 1, 2, and 3 years for the available patients. A 1:1 propensity score matching using six baseline variables was conducted to account for the nonrandom distribution of operative and nonoperative treatments.Results. Four hundred seventy-nine patients were included (OP: 258, 70.7%, NONOP:221, 47.1%). One hundred fifty-one (OP:90, NONOP:61) had complete 1, 2, and 3 year data available for QALY trending. Unmatched results are not listed in the abstract. Mean baseline utility scores were statistically similar between the matched groups (OP:0.609 +/- 0.093, NONOP: 0.600 +/- 0.091, P = 0.6401) and at 2 year min postop mean OP QALY was greater than NONOP (1.377 +/- 0.345 vs. 1.256 +/- 0.286, respectively, P < 0.01). For the subanalysis cohort, mean OP QALYs at 1, 2, and 3 years postoperative were all significantly greater than NONOP, P < 0.03 for all (1 yr: 0.651 +/- 0.089 vs. 0.61 +/- 0.079, 2 yr: 1.29 +/- 0.157 vs. 1.189 perpendicular to 0.141, and 3 yr: 1.903 +/- 0.235 vs. 1.749 perpendicular to 0.198, respectively). Matched OP had a larger QALYs gained (from baseline) at 2 year minimum postoperative (0.112 +/- 0.243 vs. 0.008 +/- 0.195, P < 0.01). For subanalysis of patients with complete 1 to 3 years data, OP had a significantly larger QALYs gained at 1, 2, and 3 years compared with NONOP: 1 year (0.073 +/- 0.121 vs. 0.029 +/- 0.082, P = 0.0447), 2 years (0.167 +/- 0.232 vs. 0.036 +/- 0.173, P = 0.0030), and 3years (0.238 +/- 0.379 vs. 0.059 +/- 0.258, P < 0.01).Conclusion. The operative treatment of adult spinal deformity results in significantly greater mean QALYs and QALYs gained at minimum 2 years postop as well as at the 1-, 2-, and 3-year time points compared with nonoperative management.