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National Administrative Databases in Adult Spinal Deformity Surgery: A Cautionary Tale
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
cost of index surgery was $71,992 and 2-year costs, including revisions, was $80,027. There were statistically significant differences in index costs of surgery and 2-year inpatient costs across centers. The average 2-year QALY was 0.2, with all centers having incremental 2-year QALY improvements, which were not statistically different (p=.15). There were significant differences in patient age, levels fused, BMP use, operative time and osteotomies performed (p<.05). Variation in other patient demographics; length of stay, expected blood loss, interbody fusions and decompressions were not statistically significant. Index surgical costs varied by as much as 30% between centers and the incremental costs at two-year follow up varied across sites from 3.5% to 26%. CONCLUSIONS: Two-year incremental QALY improvements were consistent across centers, but there was significant variability in both index surgical costs and two-year episode of care costs. The lack of variability in outcome measures between centers indicates that attempts to optimize incremental cost effectiveness of surgical treatment of adult spinal deformity should focus heavily on both reducing index surgical costs and increasing the durability of intervention, both areas in which variability between centers was identified. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.084
74. National Administrative Databases in Adult Spinal Deformity Surgery: A Cautionary Tale Aaron J. Buckland, MBBS, FRACS1, Gregory W. Poorman, BA1, Cyrus M. Jalai, BA1, Eric O. Klineberg, MD2, Michael P. Kelly, MD3, Peter G. Passias, MD4, International Spine Study Group5; 1Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 2UC Davis School of Medicine, Sacramento, CA, USA; 3Washington University, Saint Louis, MO, USA; 4NY Spine Institute, NYU Medical Center Hospital for Joint Diseases, New York, NY, USA; 5Brighton, CO, USA BACKGROUND CONTEXT: National Administrative Databases (NADs) have become a high volume source of publications in adult spinal deformity (ASD), utilizing billing codes as a surrogate for medical and surgical diagnoses, procedures and complications. These have become popular due to large patient volumes and no requirement for Institutional Review Board approval. NADs represent a different patient population to a physicianmanaged database (PMD). NADs do not allow tracking of patients over time. PURPOSE: To compare and contrast the patient population reported in NADs and a multicenter PMD, and trends in use of deformity codes for spinal surgery. STUDY DESIGN/SETTING: Comparison between national administrative databases and a prospective multicenter physician managed database. PATIENT SAMPLE: National Inpatient Sample (NIS), National Surgical Quality Improvement Program (NSQIP) and multicenter prospective adult spinal deformity database. OUTCOME MEASURES: Prevalence of spinal deformity billing codes in NADs. Comparison of invasiveness, use of osteotomies, and levels fused between databases. METHODS: The NIS was searched for years 2002–2012 and NSQIP for years 2006–2013 using validated spinal deformity diagnostic codes. Procedural codes (ICD-9 and CPT) were then applied to each database. A multicenter PMD (PON), including years 2008–2015 was used for comparison. Databases were assessed for levels fused, osteotomies, decompressed levels, and invasiveness (a product of these parameters). Database comparisons were made in all patients, and also for patients with at least 5 level spinal fusions. RESULTS: Patients identified for the study included 37368 NIS patients, 1291 NSQIP patients and 737 PON patients. NADs showed an increased use of deformity billing codes over the study period (NIS doubled, 68x NSQIP, p<.001), but remained stable in the PMD. Despite primary diagnosis of spinal deformity, surgical invasiveness was lower for all patients in the NIS (11.4–13.7) and NSQIP databases (6.4–12.7) compared to PON (27.5–32.3). When limited to ≥5 levels, invasiveness, levels fused, and use of 3-column osteotomies remained significantly higher in the PMD compared with NABs (p<.001).
CONCLUSIONS: Billing code databases NIS and NSQIP do not capture the same patient population or detailed data granularity, as Physician Managed Databases in Adult Spinal Deformity. Physicians should remain cautious in interpreting conclusions drawn from these high-volume datasets. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.085
75. Risk of Total Hip Arthroplasty Dislocation after Adult Spinal Deformity Correction Aaron J. Buckland, MBBS, FRACS1, Robert A. Hart, MD2, Gregory M. Mundis Jr., MD3, Daniel M. Sciubba, MD4, Renaud Lafage, MSc5, Thomas J. Errico, MD1, Shay Bess, MD1, Jonathan Vigdorchik, MD6, Ran Schwarzkopf, MD7, Virginie Lafage, PhD5, International Spine Study Group8; 1Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 2 Oregon Health & Science University, Portland, OR, USA; 3Department of Orthopedics, Scripps Clinic Medical Group, La Jolla, CA, USA; 4John Hopkins University/School of Medicine, Baltimore, MD, USA; 5Hospital for Special Surgery, New York, NY, USA; 6New York, NY, USA; 7NYU, New York, NY, USA; 8Brighton, CO, USA BACKGROUND CONTEXT: Adult spinal deformity (ASD) correction results in changes in acetabular anteversion. Spinopelvic fusion also reduces the protective motion of the pelvis between sitting and standing to prevent total hip arthroplasty (THA) dislocation. The prevalence of dislocation of THA after ASD correction has not previously been studied. PURPOSE: To identify the prevalence of revision for dislocation of previously stable THA in patients undergoing ASD correction surgery. STUDY DESIGN/SETTING: Retrospective clinical and radiological review of prospective multicenter spinal deformity database. PATIENT SAMPLE: Patients with previously implanted THA were identified from a prospective database of patients undergoing spinal realignment for ASD if they had a THA in situ prior to spinal realignment. OUTCOME MEASURES: Revision of previously stable THA after ASD correction. METHODS: Patients with previously implanted THA were identified from a prospective database of patients undergoing spinal realignment for ASD if they had a THA in situ prior to spinal realignment. Only patients with at least 6 months postoperative follow-up and visible THA prostheses were included. All postoperative imaging was reviewed until most recent followup to identify any changes in THA components. A further chart review was performed to determine the indication for all revised THAs. Acetabular orientation was measured pre- and post-SSD correction as were global and regional spinopelvic parameters. RESULTS: Forty-two patients (53 THAs) met the inclusion and exclusion criteria. Twenty-seven of these patients underwent a 3-column osteotomy. Four patients (7.2% of patients – 5.7% hips) required revision of a THA after spinal realignment procedure: all revisions were for recurrent dislocation of the prosthesis. All had stable THAs prior to spinal realignment surgery. All acetabular components were within Lewinnek’s “safe zone” after ASD correction. The degree of sagittal spinal correction was not significantly different between the revised and non-revised group, nor was the mean anteversion, inclination or amount of change in acetabular prosthesis alignment. All hips requiring revision were fused to the pelvis as part of their SSD correction CONCLUSIONS: Dislocation of a previously stable THA is a potential complication after SSD correction. Instability may be a result of a combination of change in alignment of the acetabular prosthesis, as well as reduced spinopelvic motion from spinopelvic fusion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.086
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S113–S250
cost of index surgery was $71,992 and 2-year costs, including revisions, was $80,027. There were statistically significant differences in index costs of surgery and 2-year inpatient costs across centers. The average 2-year QALY was 0.2, with all centers having incremental 2-year QALY improvements, which were not statistically different (p=.15). There were significant differences in patient age, levels fused, BMP use, operative time and osteotomies performed (p<.05). Variation in other patient demographics; length of stay, expected blood loss, interbody fusions and decompressions were not statistically significant. Index surgical costs varied by as much as 30% between centers and the incremental costs at two-year follow up varied across sites from 3.5% to 26%. CONCLUSIONS: Two-year incremental QALY improvements were consistent across centers, but there was significant variability in both index surgical costs and two-year episode of care costs. The lack of variability in outcome measures between centers indicates that attempts to optimize incremental cost effectiveness of surgical treatment of adult spinal deformity should focus heavily on both reducing index surgical costs and increasing the durability of intervention, both areas in which variability between centers was identified. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.084
74. National Administrative Databases in Adult Spinal Deformity Surgery: A Cautionary Tale Aaron J. Buckland, MBBS, FRACS1, Gregory W. Poorman, BA1, Cyrus M. Jalai, BA1, Eric O. Klineberg, MD2, Michael P. Kelly, MD3, Peter G. Passias, MD4, International Spine Study Group5; 1Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 2UC Davis School of Medicine, Sacramento, CA, USA; 3Washington University, Saint Louis, MO, USA; 4NY Spine Institute, NYU Medical Center Hospital for Joint Diseases, New York, NY, USA; 5Brighton, CO, USA BACKGROUND CONTEXT: National Administrative Databases (NADs) have become a high volume source of publications in adult spinal deformity (ASD), utilizing billing codes as a surrogate for medical and surgical diagnoses, procedures and complications. These have become popular due to large patient volumes and no requirement for Institutional Review Board approval. NADs represent a different patient population to a physicianmanaged database (PMD). NADs do not allow tracking of patients over time. PURPOSE: To compare and contrast the patient population reported in NADs and a multicenter PMD, and trends in use of deformity codes for spinal surgery. STUDY DESIGN/SETTING: Comparison between national administrative databases and a prospective multicenter physician managed database. PATIENT SAMPLE: National Inpatient Sample (NIS), National Surgical Quality Improvement Program (NSQIP) and multicenter prospective adult spinal deformity database. OUTCOME MEASURES: Prevalence of spinal deformity billing codes in NADs. Comparison of invasiveness, use of osteotomies, and levels fused between databases. METHODS: The NIS was searched for years 2002–2012 and NSQIP for years 2006–2013 using validated spinal deformity diagnostic codes. Procedural codes (ICD-9 and CPT) were then applied to each database. A multicenter PMD (PON), including years 2008–2015 was used for comparison. Databases were assessed for levels fused, osteotomies, decompressed levels, and invasiveness (a product of these parameters). Database comparisons were made in all patients, and also for patients with at least 5 level spinal fusions. RESULTS: Patients identified for the study included 37368 NIS patients, 1291 NSQIP patients and 737 PON patients. NADs showed an increased use of deformity billing codes over the study period (NIS doubled, 68x NSQIP, p<.001), but remained stable in the PMD. Despite primary diagnosis of spinal deformity, surgical invasiveness was lower for all patients in the NIS (11.4–13.7) and NSQIP databases (6.4–12.7) compared to PON (27.5–32.3). When limited to ≥5 levels, invasiveness, levels fused, and use of 3-column osteotomies remained significantly higher in the PMD compared with NABs (p<.001).
CONCLUSIONS: Billing code databases NIS and NSQIP do not capture the same patient population or detailed data granularity, as Physician Managed Databases in Adult Spinal Deformity. Physicians should remain cautious in interpreting conclusions drawn from these high-volume datasets. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.085
75. Risk of Total Hip Arthroplasty Dislocation after Adult Spinal Deformity Correction Aaron J. Buckland, MBBS, FRACS1, Robert A. Hart, MD2, Gregory M. Mundis Jr., MD3, Daniel M. Sciubba, MD4, Renaud Lafage, MSc5, Thomas J. Errico, MD1, Shay Bess, MD1, Jonathan Vigdorchik, MD6, Ran Schwarzkopf, MD7, Virginie Lafage, PhD5, International Spine Study Group8; 1Hospital for Joint Diseases at NYU Langone Medical Center, New York, NY, USA; 2 Oregon Health & Science University, Portland, OR, USA; 3Department of Orthopedics, Scripps Clinic Medical Group, La Jolla, CA, USA; 4John Hopkins University/School of Medicine, Baltimore, MD, USA; 5Hospital for Special Surgery, New York, NY, USA; 6New York, NY, USA; 7NYU, New York, NY, USA; 8Brighton, CO, USA BACKGROUND CONTEXT: Adult spinal deformity (ASD) correction results in changes in acetabular anteversion. Spinopelvic fusion also reduces the protective motion of the pelvis between sitting and standing to prevent total hip arthroplasty (THA) dislocation. The prevalence of dislocation of THA after ASD correction has not previously been studied. PURPOSE: To identify the prevalence of revision for dislocation of previously stable THA in patients undergoing ASD correction surgery. STUDY DESIGN/SETTING: Retrospective clinical and radiological review of prospective multicenter spinal deformity database. PATIENT SAMPLE: Patients with previously implanted THA were identified from a prospective database of patients undergoing spinal realignment for ASD if they had a THA in situ prior to spinal realignment. OUTCOME MEASURES: Revision of previously stable THA after ASD correction. METHODS: Patients with previously implanted THA were identified from a prospective database of patients undergoing spinal realignment for ASD if they had a THA in situ prior to spinal realignment. Only patients with at least 6 months postoperative follow-up and visible THA prostheses were included. All postoperative imaging was reviewed until most recent followup to identify any changes in THA components. A further chart review was performed to determine the indication for all revised THAs. Acetabular orientation was measured pre- and post-SSD correction as were global and regional spinopelvic parameters. RESULTS: Forty-two patients (53 THAs) met the inclusion and exclusion criteria. Twenty-seven of these patients underwent a 3-column osteotomy. Four patients (7.2% of patients – 5.7% hips) required revision of a THA after spinal realignment procedure: all revisions were for recurrent dislocation of the prosthesis. All had stable THAs prior to spinal realignment surgery. All acetabular components were within Lewinnek’s “safe zone” after ASD correction. The degree of sagittal spinal correction was not significantly different between the revised and non-revised group, nor was the mean anteversion, inclination or amount of change in acetabular prosthesis alignment. All hips requiring revision were fused to the pelvis as part of their SSD correction CONCLUSIONS: Dislocation of a previously stable THA is a potential complication after SSD correction. Instability may be a result of a combination of change in alignment of the acetabular prosthesis, as well as reduced spinopelvic motion from spinopelvic fusion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.086
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.