Demographics and Medical Comorbidities as Risk Factors for Increased Episode of Care Costs Following Lumbar Fusion in Medicare Patients.

The objective was to evaluate medical comorbidities and surgical variables as independent risk factors for increased health care costs in Medicare patients undergoing lumbar fusion. Care episodes limited to lumbar fusions were retrospectively reviewed on the Centers of Medicare and Medicaid Innovation (CMMI) Bundled Payment for Care Improvement (BPCI) reimbursement database at a single academic institution. Total episode of care cost was also collected. A multivariable linear regression model was developed to identify independent risk factors for increased total episode of care cost, and logistic models for surgical complications and readmission. A total of 500 Medicare patients were included. Risk factors associated with increased total episode of care cost included transforaminal interbody fusion (TLIF) and anterior lumbar interbody fusion (ALIF) (ß = $5,399, P < 0.001) and ALIF+PLF (AP) fusions (ß = $24,488, P < 0.001), levels fused (ß = $3,989, P < 0.001), congestive heart failure (ß = $6,161, P = 0.022), hypertension with end-organ damage (ß = $10,138, P < 0.001), liver disease (ß = $16,682, P < 0.001), inpatient complications (ß = $4,548, P = 0.001), 90-day complications (ß = $10,012, P = 0.001), and 90-day readmissions (ß = $15,677, P < 0.001). The most common surgical complication was postoperative anemia, which was associated with significantly increased costs (ß = $18,478, P < 0.001). Female sex (OR = 2.27, P = 0.001), AP fusion (OR = 2.59, P = 0.002), levels fused (OR = 1.45, P = 0.005), cerebrovascular disease (OR = 4.19, P = 0.003), cardiac arrhythmias (OR = 2.32, P = 0.002), and fluid electrolyte disorders (OR = 4.24, P = 0.002) were independent predictors of surgical complications. Body mass index (OR = 1.07, P = 0.029) and AP fusions (OR = 2.87, P = 0.049) were independent predictors of surgical readmission. Among medical comorbidities, congestive heart failure, hypertension with end-organ damage, and liver disease were independently associated with a significant increase in total episode of care cost. Interbody devices were associated with increased admission cost.

Does Cervical Spondylolisthesis Influence Patient-Reported Outcomes After Anterior Cervical Discectomy and Fusion Surgery?

BACKGROUND: No prior work has explored whether the presence of degenerative spondylolisthesis impacts patient-reported outcome measurements (PROMs) after an anterior cervical discectomy and fusion (ACDF); therefore, the goal of the current study was to determine whether the presence of a spondylolisthesis affects PROMs after an ACDF. METHODS: A retrospective cohort study was conducted on patients over the age of 18 who underwent a 1- or 2-level ACDF. All patients received preoperative standing lateral x-rays and were placed into 1 of 2 groups based on the presence of cervical spondylolisthesis from C2-T1: (1) no spondylolisthesis (NS) group or (2) spondylolisthesis (S) group. Preoperative, postoperative, and delta (postoperative minus preoperative) were recorded and compared between groups via univariate and multivariate analysis. Outcomes reported were the Physical Component Scores of the Short Form-12 (PCS-12), the Mental Component Scores of the Short Form-12 (MCS-12), the Neck Disability Index (NDI), and visual analog scale (VAS) Arm/Neck. RESULTS: A total of 202 patients were included in the final analysis with 154 in the NS group and 48 in the S group. Both patient cohorts reported significant postoperative improvement in PCS-12, NDI, and VAS Arm/Neck. When comparing outcome scores between groups, only MCS-12 delta scores were different between groups, with the S group exhibiting a greater mean delta score (8.3 vs 1.3, P = 0.024) than the NS group after ACDF. Multiple linear regression analysis indicated having spondylolisthesis at baseline was a significant predictor of greater change in MCS-12 than the NS group (ß = 4.841; 95% CI, 0.876, 8.805; P = 0.017). CONCLUSION: Both groups demonstrated significant postoperative improvement in PCS-12, NDI, or VAS Neck/Arm pain scores with no significant differences between groups. Patients with spondylolisthesis were found to have significantly greater improvement scores in MCS-12 scoring than those without spondylolisthesis after ACDF surgery.

Adjacent level disease-background and update based on disc replacement data.

PURPOSE OF REVIEW: The precise etiology of adjacent segment disease following cervical spine surgery is controversial. Theories for development include inevitable changes secondary to the natural progression of the degenerative cascade and changes secondary to altered biomechanics of the fused cervical spine. Motion preserving techniques, such as cervical disc arthroplasties (CDA), have been introduced with the hopes of reducing the rates of adjacent segment pathology. Recently, 7-year data from the investigational device exemption (IDE) studies have been published. The purpose of this review is to provide an update on cervical adjacent segment disease incorporating this emerging data into the analysis. RECENT FINDINGS: Although the 7-year data for CDA has confirmed continued success, specifically regarding improved neck pain and reduced re-operation rates, the influence of CDA on reducing rates of adjacent segment pathology remains questionable. Although some studies have found more radiographic adjacent segment disease after anterior cervical discectomy and fusion (ACDF) compared to CDA, an association between these findings and clinical symptoms has not been established. Cervical disc arthroplasty continues to outperform cervical disc fusion regarding some patient specific parameters, however, whether CDA reduces rates of radiographic and clinical adjacent segment pathology remains unknown. Without studies developed specifically to address this question, the answer remains elusive.