Abstract
Purpose
To compare direct costs of index and revision operations of thoracic posterior spinal instrumented fusion (TPSIF) and thoracic anterior spinal tethering (TAST) for adolescent idiopathic thoracic scoliosis in children.
Methods
Children (ages 11–18 years) who underwent TPSIF and TAST (2/2013–9/2019) were reviewed. Follow-up < 2 years and cervical instrumentation and/or instrumentation of a lumbar level at L3 or below were exclusion criteria. Patient demographics, radiographic curve magnitude, index operations and postoperative data, as well as indications for revisions/readmissions were collected. Direct costs were identified and compared for index and revision operations during follow-up.
Results
One hundred and four patients were included (TPSIF: 78; TAST: 25). TAST procedures were performed in children significantly younger and for smaller curve magnitudes. They had significantly fewer levels instrumented, shorter operating room (OR) times, and less estimated blood loss (EBL). After operation, a significantly higher percentage of TAST were admitted to ICU. Hospital length of stay (LOS) was similar between groups. Index operations’ average direct costs were significantly higher for TAST than TPSIF ($52,947 v. $46,641; p = 0.02). Major cost drivers for both groups were implants, OR services, post-anesthesia care unit (PACU), and room/board.
Revisions following TAST were more frequent than for TPSIF (36 v. 11.5%). Majority of TPSIF revisions were for junctional deformity. Curve progression and overcorrection were most common reason for TAST revisions. Average direct costs for revisions/readmissions were similar between groups (TPSIF: $28,485 v. TAST: $27,590; p = 0.46).
Conclusions
Index operations’ average direct costs were statistically similar between TPSIF and TAST for adolescent idiopathic scoliosis. Major cost drivers were implants, OR services, PACU, and room/board. TAST index operations’ direct costs and associated direct costs for implants and room/board were significantly higher, while their anesthesia and OR services were significantly lower than TPSIF. TAST revisions were for overcorrection and curve progression, while TPSIF revisions were most commonly for junctional deformity. Overall average direct costs for revisions were similar despite revision rates being higher for TAST.
Level of evidence
III.
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References
Bauer JM, Yorgova P, Neiss G et al (2019r) Early onset scoliosis: is there an improvement in quality of life with conversion from traditional growing rods to magnetically controlled growing rods? J Pediatr Orthop 39(4):e284–e288
Parent S, Shen J (2020) Anterior vertebral body growth-modulation tethering in idiopathic scoliosis: surgical technique. J Am Acad Orthop Surg 28(17):693–699. https://doi.org/10.5435/JAAOS-D-19-00849
Samdani AF, Ames RJ, Kimball JS et al (2015) Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients. Eur Spine J 24(7):1533–1539. https://doi.org/10.1007/s00586-014-3706-z
Samdani AF, Pahys JM, Ames RJ et al (2021) Prospective follow-up report on anterior vertebral body tethering for idiopathic scoliosis: interim results from an FDA IDE study. J Bone Joint Surg Am 103(17):1611–1619. https://doi.org/10.2106/JBJS.20.01503
Qiu C, Talwar D, Gordon J et al (2021) Patient-reported outcomes are equivalent in patients who receive vertebral body tethering versus posterior spinal fusion in adolescent idiopathic scoliosis. Orthopedics 44(1):24–28. https://doi.org/10.3928/01477447-20201119-02
Hoernschemeyer DG, Boeyer ME, Robertson ME et al (2020) Anterior vertebral body tethering for adolescent scoliosis with growth remaining: a retrospective review of 2 to 5-year postoperative results. J Bone Joint Surg Am 102(13):1169–1176. https://doi.org/10.2106/JBJS.19.00980
Baker CE, Kiebzak GM, Neal KM (2021) Anterior vertebral body tethering shows mixed results at 2-year follow-up. Spine Deform 9(2):481–489. https://doi.org/10.1007/s43390-020-00226-x
Miyanji F, Pawelek J, Nasto LA et al (2020) Safety and efficacy of anterior vertebral body tethering in the treatment of idiopathic scoliosis. Bone Joint J 102-B(12):1703–1708. https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-0426.R1
Rushton PRP, Nasto L, Parent S et al (2021) Anterior vertebral body tethering (AVBT) for treatment of idiopathic scoliosis in the skeletally immature: results of 112 cases. Spine. https://doi.org/10.1097/BRS.0000000000004061
Abdullah A, Parent S, Miyanji F et al (2021) Risk of early complication following anterior vertebral body tethering for idiopathic scoliosis. Spine Deform 9(5):1419–1431. https://doi.org/10.1007/s43390-021-00326-2
Baroncini A, Trobisch PD, Birkenmaier C et al (2021) Radiographic Results after Vertebral Body Tethering. Z Orthop Unfall. https://doi.org/10.1055/a-1387-8334
Shin M, Arguelles GR, Cahill PJ et al (2021) Complications, reoperations, and mid-term outcomes following anterior vertebral body tethering versus posterior spinal fusion: a meta-analysis. JB JS Open Access. 6(2):e2.100002. https://doi.org/10.2106/JBJS.OA.21.00002
Theologis AA, Ramirez J, Diab M (2020) Preoperative CT angiography informs instrumentation in anterior spine surgery for idiopathic scoliosis. J Am Acad Orthop Surg Glob Res Rev 4(4):e19.00123. https://doi.org/10.5435/JAAOSGlobal-D-19-00123
Clark JP 3rd, Diab M (2020) Neurophysiologic detection of spinal cord ischemia during anterior vertebral tethering. Spine. 45(24):E1703–E1706. https://doi.org/10.1097/BRS.0000000000003688
Segal DN, Ball J, Fletcher ND et al (2022) Risk factors for the development of DJK in AIS patients undergoing posterior spinal instrumentation and fusion. Spine Deform 10(2):377–385. https://doi.org/10.1007/s43390-021-00413-4
Marciano G, Ball J, Matsumoto H et al (2021) Including the stable sagittal vertebra in the fusion for adolescent idiopathic scoliosis reduces the risk of distal junctional kyphosis in Lenke 1–3 B and C curves. Spine Deform 9(3):733–741. https://doi.org/10.1007/s43390-020-00259-2
Yang J, Andras LM, Broom AM et al (2018) Preventing distal junctional kyphosis by applying the stable sagittal vertebra concept to selective thoracic fusion in adolescent idiopathic scoliosis. Spine Deform 6(1):38–42. https://doi.org/10.1016/j.jspd.2017.06.007
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AAT, H-HW, and MD made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; AAT, H-HW, and MD drafted the work or revised it critically for important intellectual content; AAT, H-HW, and MD approved the version to be published; AAT, H-HW, and MD agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Theologis, A.A., Wu, HH. & Diab, M. Thoracic posterior spinal instrumented fusion vs. thoracic anterior spinal tethering for adolescent idiopathic scoliosis with a minimum of 2-year follow-up: a cost comparison of index and revision operations. Spine Deform 11, 359–366 (2023). https://doi.org/10.1007/s43390-022-00586-6
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DOI: https://doi.org/10.1007/s43390-022-00586-6