Cost comparisons and perioperative outcomes in the surgical treatment of tandem spinal stenosis
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Published on: February 9, 2024
Patrick K Cronin1, Kaitlyn E Holly1, Malina O Hatton2
1Department of Orthopaedic Surgery, Mass General Brigham, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Background Context:
As the population ages, tandem spinal stenosis (TSS; symptomatic concomitant cervical and lumbar stenosis) can be anticipated to increase in prevalence. TSS can be challenging as it typically presents in older individuals with comorbidities and frailty.
Purpose:
To evaluate clinical and demographic factors associated with episode costs and outcomes following treatment for cervical-lumbar TSS.
Study Design/Setting:
Retrospective analysis.
Patient Sample:
We identified all patients who underwent an elective surgery for cervical and lumbar stenosis (2015-22). Patients were included if they underwent an elective surgery for cervical and lumbar stenosis within 12-months of each other for the clinical conditions of spinal stenosis, radiculopathy and/or spondylolisthesis. Procedures were categorized based on intensity: anterior cervical decompression and fusion and posterior lumbar laminectomy (least intense), posterior cervical procedure and lumbar laminectomy, anterior cervical decompression and fusion and lumbar decompression and fusion and posterior cervical procedure and lumbar decompression and fusion (most intense).
Outcome Measures:
The primary outcome was procedural costs. Peri-operative outcomes and complications were also considered.
Methods:
Generalized linear modeling was used to determine the independent association of the procedural approach with total healthcare costs, length of stay, EBL, and OR time. Logistic regression was used to adjust for confounding associated with infection, pooled complications, 90-day readmissions, 90-day revision and 2-year revision. All analyses accounted for age, biologic sex and Charlson Comorbidity Index (CCI).
Results:
We identified 174 patients. In adjusted analysis, posterior cervical surgery with lumbar decompression and fusion was significantly more expensive (1.6; 95% CI: 1.28, 1.99) than anterior cervical fusion and lumbar laminectomy, as were anterior cervical with lumbar fusion (1.6; 95% CI: 1.28, 2.0) and posterior cervical procedure with lumbar laminectomy (1.3; 95% CI: 1.05, 1.60). Similar findings were encountered for blood loss and length of stay. Posterior cervical procedures and lumbar laminectomy were significantly associated with increased odds of infection (OR: 14.0; 95% CI: 1.07, >999).
Conclusions:
We advocate a reliance on the least intensive surgical technique that would be expected to provide a satisfactory postoperative result. We believe that such an approach has the capacity to lower adverse events and reduce healthcare expenditures.
