6 Points on Quality & Cost Outcomes for Adult Scoliosis Surgery

The retrospective review of a prospective, multi-center database included 1,750 patients who underwent surgery for scoliosis. The researchers found:

1. Older patients, those with revision surgeries and patients who had an osteotomy had significantly higher Oswestry Disability Index scores. Patients older than 65 years had higher ODI than the younger patients. Here is the breakdown at each period postoperatively for the difference between over 65 and under 65 year old patients:

•    Baseline to six weeks: -2.6 difference
•    Baseline to six months: -3.7 difference
•    Baseline to one year: -4.0 difference
•    Baseline to two years: -3.7 difference
•    Baseline to three years: -2.8 difference
•    Baseline to five years: -1.5 difference

"Degenerative scoliosis is a common condition in the growing elderly population; 30 percent of patients present for the first time in adulthood," said the study authors in the discussion. "Although many of these deformities may be minor and cause few to no symptoms, many experience imbalance, severe pain and even neurological deficits as a result of stenosis and spondylolisthesis."

2. Patients with seven or fewer levels fused reported significantly higher ODI scores than those who had more than seven levels fused at the baseline, one year, two years and five years postoperatively. Among patients who had seven or fewer levels fused, the ODI score decreased significantly from baseline to six weeks and six weeks to six months. Then the ODI score was unchanged through five years follow up.

3. Most of the patients reported unchanged outcomes throughout the postoperative period from one year to five years. "Surgical treatment has the potential to significantly improve the quality of life of patients with adult scoliosis," concluded the study authors. "An understanding of the timing of improvement after surgery will improve both the counseling of surgical candidates and patient care pathways."

There was no significant difference in ODI scores in patients with intraoperative complications compared with those who didn't have intraoperative complications. But patients with postoperative complications had greater ODI scores at six month follow-ups than those with no postoperative complications. A 2011 study published in Spine shows an overall complication rate for adult scoliosis surgery at 13.4 percent, based on data from the SRS morbidity and mortality database.

4. Patients who underwent staged surgeries had lower ODI scores than patients who were not undergoing staged surgery at six weeks and six months after surgery. Patients with staged surgeries reported a decrease in ODI scores at six weeks and six months to the one-year follow up, but then the ODI score remained unchanged from one- to five-years postoperatively.

5. The anatomical region of surgery also made a difference. The ODI score for lumbar-only procedures from baseline to six weeks and from six weeks to six months decreased. Then the score remained unchanged from six months to five years postoperatively. For combined lumbar and thoracic cases, the ODI score increased from baseline to six weeks but then decreased from six weeks to six months and then six months to one year follow-up. The ODI score then remained unchanged through the five year follow-up.

6. A cost-analysis shared at the International Society for the Advancement of Spine Surgery annual meeting of adult scoliosis surgery found the average total surgical and hospital cost was $47,127. Average total charge was $140,286 and average total reimbursement was $62,138. The hospital was reimbursed 44 percent of total charges and 132 percent of total costs.

The largest contributors to overall cost were:

•    Implants — 29 percent
•    Inpatient room/ICU — 20 percent
•    Operating room/recovery room — 12 percent
•    Operating room instruments — 8 percent
•    Bone graft — 6 percent

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