Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention
Examination of the Economic Burden of Frailty in Patients With Adult Spinal Deformity Undergoing Surgical Intervention
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接受手术干预的成人脊柱畸形患者虚弱经济负担的检查
DOI：
10.1227/neu.0000000000001756
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发表时间：
2021
期刊：
影响因子：
4.8
通讯作者：
S. Bess
中科院分区：
文献类型：
--
作者：
P. Passias;Waleed Ahmad;Nicholas A Kummer;R. Lafage;V. Lafage;K. Kebaish;Alan H. Daniels;E. Klineberg;A. Sorocéanu;Jeffrey L. Gum;Breton G. Line;R. Hart;D. Burton;R. Eastlack;Amit Jain;Justin S. Smith;C. Ames;C. Shaffrey;F. Schwab;R. Hostin;S. Bess
背景技术背景：随着对成本优化的兴趣日益增加，成人脊柱畸形（ASD）手术的成本与脆弱性交叉值得研究。目的：调查与ASD和虚弱相关的费用。方法：纳入具有基线和2年影像学数据的ASD患者（脊柱侧凸≥20°，矢状面垂直轴[SVA] ≥5 cm，骨盆倾斜≥ 25°或胸椎后凸≥ 60°）。患者为严重虚弱（SF）、虚弱（F）或不虚弱（NF）。效用数据从奥斯韦斯特里残疾指数转换为简明六维量表。质量调整寿命年（Qs）使用3%的预期寿命下降率。使用Pearldiver计算成本。工作损失成本基于SRS-22 rQ 9和美国劳工统计局。考虑并发症、住院时间、翻修和死亡，计算2年时每个QALY的成本和预期寿命。研究结果：592例ASD患者入选（59.8 ± 14.0岁，80%女性，体重指数：27.7 ± 6.0 kg/m2，成人脊柱畸形-虚弱指数：3.3 ± 1.6，Charlson合并症指数：1.8 ± 1.7）。平均出血量1569.3 mL，手术时间376.6 min，其中截骨占63%，减压占54%。69.3%仅采用后路，30%采用联合入路，0.7%仅采用前路。4.7%为SF，22.3%为F，73.0%为NF。基线时，104人失业，每周损失971.38美元。一年后，62人仍然失业，每年损失50 508.64美元。在基线SVA的倾向评分匹配下，F/SF患者2年ASD手术费用高于NF患者（81 347美元vs 69 722美元）。F/SF在2年时的每QALY成本高于NF（436 473美元vs 430 437美元）。在预期寿命方面，每个QALY的成本差异变得相当（58 965美元对58 149美元）。结论：尽管初始成本较高，但F和SF患者表现出更大的改善。NF和F患者的每QALY成本在预期寿命时相似。
BACKGROUND: With increasing interest in cost optimization, costs of adult spinal deformity (ASD) surgery intersections with frailty merit investigation. OBJECTIVE: To investigate costs associated with ASD and frailty. METHODS: Patients with ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥ 25°, or thoracic kyphosis ≥ 60°) with baseline and 2-yr radiographic data were included. Patients were severely frail (SF), frail (F), or not frail (NF). Utility data were converted from Oswestry Disability Index to Short-Form Six-Dimension. Quality-adjusted life years (QALYs) used 3% rate for decline to life expectancy. Costs were calculated using PearlDiver. Loss of work costs were based on SRS-22rQ9 and US Bureau of Labor Statistics. Accounting for complications, length of stay, revisions, and death, cost per QALY at 2 yr and life expectancy were calculated. RESULTS: Five hundred ninety-two patients with ASD were included (59.8 ± 14.0 yr, 80% F, body mass index: 27.7 ± 6.0 kg/m2, Adult Spinal Deformity-Frailty Index: 3.3 ± 1.6, and Charlson Comorbidity Index: 1.8 ± 1.7). The average blood loss was 1569.3 mL, and the operative time was 376.6 min, with 63% undergoing osteotomy and 54% decompression. 69.3% had a posterior-only approach, 30% combined, and 0.7% anterior-only. 4.7% were SF, 22.3% F, and 73.0% NF. At baseline, 104 were unemployed losing $971.38 weekly. After 1 yr, 62 remained unemployed losing $50 508.64 yearly. With propensity score matching for baseline SVA, cost of ASD surgery at 2 yr for F/SF was greater than that for NF ($81 347 vs $69 722). Cost per QALY was higher for F/SF at 2 yr than that for NF ($436 473 vs $430 437). At life expectancy, cost per QALY differences became comparable ($58 965 vs $58 149). CONCLUSION: Despite greater initial cost, F and SF patients show greater improvement. Cost per QALY for NF and F patients becomes similar at life expectancy.
脆弱共识：行动呼吁。
DOI：
10.1016/j.jamda.2013.03.022
发表时间：
2013-06
影响因子：
7.6
作者：
Morley JE;Vellas B;van Kan GA;Anker SD;Bauer JM;Bernabei R;Cesari M;Chumlea WC;Doehner W;Evans J;Fried LP;Guralnik JM;Katz PR;Malmstrom TK;McCarter RJ;Gutierrez Robledo LM;Rockwood K;von Haehling S;Vandewoude MF;Walston J
通讯作者：
Walston J