- Email: [email protected]
P72. Drivers of episode payments for non-cervical spinal fusion
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194 patients had lower ICER values. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. In addition, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow-up times, these findings support the cost effectiveness of ASD surgery at all frailty states. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.494
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days (OR: 0.75, 95%CI: 0.66-0.86, p<0.001), and 1-year (OR: 0.84, 95%CI: 0.77-0.91, p<0.001) post index procedure. CONCLUSIONS: Elective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days post-operatively. Teaching hospitals may provide a protective effect in terms of reducing return to the OR, with a decreased risk at 30 days, 90 days and 1 year post-operatively. These findings suggest that teaching hospitals may benefit from reimbursement tied to competition on clinical metrics. Further investigation is necessary to determine the reasons for increased costs for patients undergoing laminectomy and discectomy at academic centers. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
P71. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases? Dean C. Perfetti, MD, MPH1, Alexander M. Satin, MD2, Jeffrey A. Goldstein, MD3, Jeff S. Silber, MD, DC4, David A. Essig, MD5; 1 Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, US; 2 Long Island Jewish Medical Center, New Hyde Park, NY, US; 3 Queens, NY, US; 4 Great Neck, NY, US; 5 Northwell Health, Great Neck, NY, US
P72. Drivers of episode payments for non-cervical spinal fusion Mohamed Macki, MD1, John D. Syrjamaki, MPH2, Scott E. Regenbogen, MD, MPH2, Victor Chang, MD3, David Nerenz, PhD4; 1 Henry Ford Hospital, Detroit, MI, US; 2 University of Michigan, Ann Arbor, MI, US; 3 Henry Ford West Bloomfield Hospital, West Bloomfield, MI, US; 4 Henry Ford Health System, Detroit, MI, US
BACKGROUND CONTEXT: While teaching hospitals are necessary to facilitate resident maturation, concerns have been raised about the quality of care and potential inefficiencies. In the setting of increasing health care costs and an increasing rate of elective lumbar laminectomy and discectomy, it is imperative that stakeholders involved in formulating payment models incentivizing cost efficiency understand outcomes associated with teaching status. PURPOSE: There is currently limited data on how hospital teaching status affects short term economic and clinical outcomes in patients undergoing lumbar laminectomy with or without discectomy for degenerative spine diseases. In this study, we compared the following outcomes according to academic status: (1) length of stay; (2) costs; (3) 30-day and 90-day readmission; (4) 30-day, 90-day and 1-year return to the operating room after lumbar laminectomy with or without discectomy. STUDY DESIGN/SETTING: Level III: Retrospective Cohort Study using an epidemiologic database. PATIENT SAMPLE: We identified 37,569 patients in the New York Statewide Planning and Research Cooperative System who underwent an inpatient elective lumbar laminectomy with or without discectomy in New York State between January 1, 2009 and September 30th, 2014. OUTCOME MEASURES: We compared how academic teaching status affects: length and cost of the index admission; 30- and 90-day all cause readmission; and, 30-day, 90-day and 1-year return to the operating room. METHODS: We used the New York Statewide Planning and Research Cooperative System (SPARCS) to identify inpatients in New York State who underwent elective lumbar laminectomy with or without discectomy between January 1, 2009 and September 30, 2014. Patients with diagnoses of trauma, malignancy, inflammatory disease or infection were excluded. International Classification of Diseases, Ninth Revision (ICD-9) codes were utilized to extract diagnostic and procedural codes pertaining to lumbar laminectomy and discectomy, patient demographics and outcomes of interest. SAS version 9.4 was used to conduct statistics. A unique patient identifier allowed for longitudinal follow-up. Linear and logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTS: Patients undergoing surgery at teaching hospitals had 10% shorter lengths of stay (2.7 vs 3.0 days, p<0.001) but 21.5% higher costs of admission ($13,693 vs $11,601 P<0.001); 30- and 90-day all cause readmission was not statistically different at teaching institutions compared to non-teaching (30-day OR: 1.07, 95%CI: 1.00-1.16, p=0.057; 90-day OR: 0.99, 95% CI: 0.93-1.06, p=1.06). Academic institutions had a decreased risk of return to the operating room for revision procedures or irrigation and debridement at 30-days (OR: 0.70, 95%CI: 0.60-0.82, p<0.001), 90-
BACKGROUND CONTEXT: Through alternative payment models, like those developed by the Centers for Medicare & Medicaid Services and some private payors, payments for spine surgery may now come through bundled payments for “episodes of care.” Previous publications on episode costs in spine surgery have examined all-type spinal operations, which have variations too large in costs of index hospitalizations. PURPOSE: Identify drivers of variations in the 90-day episode costs for non-cervical spinal fusions across hospital systems. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: The Michigan Value Collaborative (MVC) database was queried for 90-day episodes of care for non-cervical spine fusions. The MVC maintains a detailed claims-based registry of comprehensive 90-day episodes of care that includes charges, payor payments and utilization surrounding an admission at any one of the 79 participating acute care hospitals across the state. These hospitals were partitioned into four equally-sized quartiles based on episode payments. OUTCOME MEASURES: Claims during the 90-day episodes of care were divided into one of four categories: index hospitalization, professional services, readmissions and post-acute care. The primary outcome measure was to identify which category varied the most across the hospital quartiles for episode payments. METHODS: The four hospital quartiles of price-standardized and riskadjusted payments for spinal surgeries were compared via descriptive statistics, reporting means § standard deviations or frequencies/percentages. We used chi-square tests to compare patient characteristic differences and t-tests to compare payments at low- versus high-cost hospitals. We also calculated the percentage of total payment variation contributed by each payment component. RESULTS: Among 10,168 non-cervical spinal fusions, 90-day episode payments averaged $42,879. Payments were 17.7% greater among highest-spending than lowest-spending quartile hospitals ($47,124 vs $38,753, p<0.0001). Index hospitalization accounted for majority of payments: 73.3% in the lowest, 69.1% in the second, 63.8% in the third and 62.5% in the highest quartile. However, the maximum percent variation between the highest- and lowestquartile hospitals reached 51.4% in post-acute care, followed by 22.0% in professional fees, 14.2% in readmissions and 12.4% in index hospitalizations. In other words, the total $8,371 episode payment difference between the highestand lowest-quartile hospitals was attributable to post-acute care ($7,478 vs $3,178, p<0.0001), then professional fees ($7,675 vs $5,836, p<0.0001), readmissions ($2,497 vs $1,307, p=0.018), and index hospitalizations ($29,474 vs $28,432, p=0.019). Among sub-types of post-acute care services, the greatest difference between lowest and highest quartiles was inpatient rehab ($2,169,
https://doi.org/10.1016/j.spinee.2019.05.495
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.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
p=0.004), then skilled nursing facilities ($1,822, p=0.007) and home health ($785, p=0.007). CONCLUSIONS: Post-acute care, especially inpatient rehabilitation, is the primary driver of variation in 90-day episode payments for non-cervical spine fusions. Strategies for success in bundled payment initiatives will require attention to potentially discretionary use of post-acute care after index hospitalization. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
muscle health), 2 (adequate muscle health) and 3 (good muscle health). Higher scores corresponded to better VAS back (p=0.014), VAS leg (p=0.01), SF-12 PHS (0.027), ODI (p=0.022) and PROMIS (=0.001) scores. CONCLUSIONS: Muscle health contributes significantly to preoperative disability. When patients have combined low PL-CSA/BMI, goutallier classification and LIV this corresponds to significantly worse HRQOLs. This lumbar muscle health score is a valid screen for patients with poor muscle health which may be contributing to their disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.496 https://doi.org/10.1016/j.spinee.2019.05.497 P73. A novel preoperative MRI-based lumbar muscle health calculation to predict patient-reported health-related quality of life scores Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Avani S. Vaishnav, MBBS1, Jung Mok, BS2, Steven J. McAnany, MD3, Sravisht Iyer, MD4, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: Poor lumbar muscle health has been implicated as a source of disability for patients with low back/radicular pain. We wanted to evaluate the relationship between muscle health and patient reported quality of life scores. PURPOSE: Determine how preoperative muscle health impacts patient reported health related quality of life scores. STUDY DESIGN/SETTING: Retrospective review of imaging and outcome scores. PATIENT SAMPLE: A total of 92 adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, paralumbar muscle cross sectional area (PL-CSA), lumbar indentation value (LIV), Goutallier classification. METHODS: We performed a retrospective review of patients that had lumbar decompression and/or fusion surgery after failing nonop management for degenerative pathologies. We quantified muscle health using PL-CSA, LIV and lumbar muscle fat atrophy using the Goutallier classification. T2 MRI axial slices from the disc space at the operative level were analyzed. We graded fat atrophy on a 1-4 scale and the LIV was calculated using a published technique of measuring the distance from the tip of a spinous process and a line across the muscular fascia. We used a standardized protocol of measuring cross sectional area of the paralumbar muscle (PL-CSA). We scaled the PLCSA by finding the ratio of PL-CSA/BMI. HRQOL scores collected included VAS leg, VAS back, ODI, SF-12 mental and physical health and PROMIS. We performed a linear regression analysis to determine the relationship of LIV, PL-CSA, PL-CSA/BMI and the HRQOLs. We performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed. We combined our measurements to create a score to quantify muscle health and determined whether this score correlated with HRQOLs based on an ANOVA analysis. RESULTS: A total of 92 patients were included within our analysis. The average age was 57.9+/-14.4 years old (49 men and 43 women). There were 104 levels operated on within this cohort. The most common preoperative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV, PL-CSA and PL-CSA/BMI was 16.1 +/-7.5 mm, 4004 +/-1210 mm^2 and 153.5 +/- 45.0 mm^2/BMI. The PL-CSA/BMI ratio significantly correlated with preop SF-12 PHS (p = 0.03), VAS back (0.007) and VAS Leg (p = 0.002). Patients with less than 130 of the PL-CSA/BMI ratio had statistically significant worse PROMIS (35.9 vs 29.7, p=0.007), ODI (39.4 vs 50.2, p=0.01), SF-12 PHS (35.5 vs 28.7, =0.001), VAS leg (7.3 vs 5.5, p=0.007) and VAS back (7.9 vs 4.9, p=0.002) scores. We combined our results and scored each patient from 1-3 based upon whether there LIV <10mm or >10mm (0 or 1), Goutallier Classification >2 or <=2 (0 or 1) and whether PLCSA/BMI was >130 or <130 (0 or 1). Patients were stratified from 0-1 (poor
P74. Preoperative muscle health impacts the time taken to reach minimally clinically important differences in health-related quality of life scores for one-level lumbar fusions Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Jung Mok, BS2, Avani S. Vaishnav, MBBS1, Yahya A. Othman3, Steven J. McAnany, MD4, Sravisht Iyer, MD5, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Weill Cornell Medicine, Qatar Foundation, Rayyan, Qatar; 4 Hospital for Special Surgery, Stamford, CT, US; 5 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: There is evidence that degenerative changes in paralumbar musculature impact conditions like low back pain, and lumbar spinal stenosis. For patients undergoing spinal surgery we hypothesized that paralumbar muscle health would alter the time it took for patients to reach minimal clinically important differences (MCIDs) in health-related quality of life scores (HRQOLs). PURPOSE: Determine how preoperative muscle health impacts the time to MCID for one level MIS TLIF and/or decompression. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database PATIENT SAMPLE: Eighty-five adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, lumbar indentation value (LIV). METHODS: We performed a retrospective review of patients that eventually went on to undergo either a lumbar decompressive surgery or a 1-level lumbar spinal fusion. We analyzed magnetic resonance imaging (MRI) to quantify muscle health using the lumbar indentation value (LIV) which is a validated method of measuring the relative cross-sectional area of lumbar musculature. T2 axial slices from the disc space at the operative level were analyzed. We separated our cohort of patients into whether they had a lumbar decompression alone or 1-level TLIF. Health related quality of life (HRQOL) scores were collected on these patients in the pre-operative period and the postoperative period up to 1 year out from surgery. These scores included the Visual analog back and leg scores (VAS leg and VAS back), the oswestry disability index (ODI), short form 12 (SF-12) mental health scores (MHS) and physical health scores (PHS). We defined MCID as has been previously reported in the literature. We then correlated the LIV calculated off preoperative MRI and correlated this finding with time to MCID using a linear regression analysis. RESULTS: A total of 85 patients were included within our analysis. The average age was 58.4+/-15.7 years old and there were 45 men and 40 women. There were 93 disc spaces operated on within this cohort. The majority of patients undergoing a lumbar decompression (LD) had a diagnosis of disc herniation (49.2%) and the majority of patients that had a lumbar fusion (LF) were diagnosed with lumbar spinal stenosis (93.1%). We found that the average LIV for LD patients was 16.2+/-6.5mm and for LF patients was 17.1+/-6.6mm. There was no statistically significant correlation between time to MCID for ODI, SF-12 MHS. SF-12 PHS, VAS leg, or VAS back scores and LIV for patients undergoing a lumbar decompression. There was a statistically significant inverse relationship between time to MCID for ODI (p =0.02) and LIV and time to MCID for SF-12 MHS
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.
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days (OR: 0.75, 95%CI: 0.66-0.86, p<0.001), and 1-year (OR: 0.84, 95%CI: 0.77-0.91, p<0.001) post index procedure. CONCLUSIONS: Elective lumbar laminectomy and discectomy for degenerative lumbar conditions at teaching hospitals is associated with higher costs, but decreased length of stay and no difference in readmission rates at 30- and 90-days post-operatively. Teaching hospitals may provide a protective effect in terms of reducing return to the OR, with a decreased risk at 30 days, 90 days and 1 year post-operatively. These findings suggest that teaching hospitals may benefit from reimbursement tied to competition on clinical metrics. Further investigation is necessary to determine the reasons for increased costs for patients undergoing laminectomy and discectomy at academic centers. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
P71. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases? Dean C. Perfetti, MD, MPH1, Alexander M. Satin, MD2, Jeffrey A. Goldstein, MD3, Jeff S. Silber, MD, DC4, David A. Essig, MD5; 1 Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY, US; 2 Long Island Jewish Medical Center, New Hyde Park, NY, US; 3 Queens, NY, US; 4 Great Neck, NY, US; 5 Northwell Health, Great Neck, NY, US
P72. Drivers of episode payments for non-cervical spinal fusion Mohamed Macki, MD1, John D. Syrjamaki, MPH2, Scott E. Regenbogen, MD, MPH2, Victor Chang, MD3, David Nerenz, PhD4; 1 Henry Ford Hospital, Detroit, MI, US; 2 University of Michigan, Ann Arbor, MI, US; 3 Henry Ford West Bloomfield Hospital, West Bloomfield, MI, US; 4 Henry Ford Health System, Detroit, MI, US
BACKGROUND CONTEXT: While teaching hospitals are necessary to facilitate resident maturation, concerns have been raised about the quality of care and potential inefficiencies. In the setting of increasing health care costs and an increasing rate of elective lumbar laminectomy and discectomy, it is imperative that stakeholders involved in formulating payment models incentivizing cost efficiency understand outcomes associated with teaching status. PURPOSE: There is currently limited data on how hospital teaching status affects short term economic and clinical outcomes in patients undergoing lumbar laminectomy with or without discectomy for degenerative spine diseases. In this study, we compared the following outcomes according to academic status: (1) length of stay; (2) costs; (3) 30-day and 90-day readmission; (4) 30-day, 90-day and 1-year return to the operating room after lumbar laminectomy with or without discectomy. STUDY DESIGN/SETTING: Level III: Retrospective Cohort Study using an epidemiologic database. PATIENT SAMPLE: We identified 37,569 patients in the New York Statewide Planning and Research Cooperative System who underwent an inpatient elective lumbar laminectomy with or without discectomy in New York State between January 1, 2009 and September 30th, 2014. OUTCOME MEASURES: We compared how academic teaching status affects: length and cost of the index admission; 30- and 90-day all cause readmission; and, 30-day, 90-day and 1-year return to the operating room. METHODS: We used the New York Statewide Planning and Research Cooperative System (SPARCS) to identify inpatients in New York State who underwent elective lumbar laminectomy with or without discectomy between January 1, 2009 and September 30, 2014. Patients with diagnoses of trauma, malignancy, inflammatory disease or infection were excluded. International Classification of Diseases, Ninth Revision (ICD-9) codes were utilized to extract diagnostic and procedural codes pertaining to lumbar laminectomy and discectomy, patient demographics and outcomes of interest. SAS version 9.4 was used to conduct statistics. A unique patient identifier allowed for longitudinal follow-up. Linear and logistic regression models compared teaching and nonteaching hospitals after adjusting for patient demographics and comorbidities. RESULTS: Patients undergoing surgery at teaching hospitals had 10% shorter lengths of stay (2.7 vs 3.0 days, p<0.001) but 21.5% higher costs of admission ($13,693 vs $11,601 P<0.001); 30- and 90-day all cause readmission was not statistically different at teaching institutions compared to non-teaching (30-day OR: 1.07, 95%CI: 1.00-1.16, p=0.057; 90-day OR: 0.99, 95% CI: 0.93-1.06, p=1.06). Academic institutions had a decreased risk of return to the operating room for revision procedures or irrigation and debridement at 30-days (OR: 0.70, 95%CI: 0.60-0.82, p<0.001), 90-
BACKGROUND CONTEXT: Through alternative payment models, like those developed by the Centers for Medicare & Medicaid Services and some private payors, payments for spine surgery may now come through bundled payments for “episodes of care.” Previous publications on episode costs in spine surgery have examined all-type spinal operations, which have variations too large in costs of index hospitalizations. PURPOSE: Identify drivers of variations in the 90-day episode costs for non-cervical spinal fusions across hospital systems. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: The Michigan Value Collaborative (MVC) database was queried for 90-day episodes of care for non-cervical spine fusions. The MVC maintains a detailed claims-based registry of comprehensive 90-day episodes of care that includes charges, payor payments and utilization surrounding an admission at any one of the 79 participating acute care hospitals across the state. These hospitals were partitioned into four equally-sized quartiles based on episode payments. OUTCOME MEASURES: Claims during the 90-day episodes of care were divided into one of four categories: index hospitalization, professional services, readmissions and post-acute care. The primary outcome measure was to identify which category varied the most across the hospital quartiles for episode payments. METHODS: The four hospital quartiles of price-standardized and riskadjusted payments for spinal surgeries were compared via descriptive statistics, reporting means § standard deviations or frequencies/percentages. We used chi-square tests to compare patient characteristic differences and t-tests to compare payments at low- versus high-cost hospitals. We also calculated the percentage of total payment variation contributed by each payment component. RESULTS: Among 10,168 non-cervical spinal fusions, 90-day episode payments averaged $42,879. Payments were 17.7% greater among highest-spending than lowest-spending quartile hospitals ($47,124 vs $38,753, p<0.0001). Index hospitalization accounted for majority of payments: 73.3% in the lowest, 69.1% in the second, 63.8% in the third and 62.5% in the highest quartile. However, the maximum percent variation between the highest- and lowestquartile hospitals reached 51.4% in post-acute care, followed by 22.0% in professional fees, 14.2% in readmissions and 12.4% in index hospitalizations. In other words, the total $8,371 episode payment difference between the highestand lowest-quartile hospitals was attributable to post-acute care ($7,478 vs $3,178, p<0.0001), then professional fees ($7,675 vs $5,836, p<0.0001), readmissions ($2,497 vs $1,307, p=0.018), and index hospitalizations ($29,474 vs $28,432, p=0.019). Among sub-types of post-acute care services, the greatest difference between lowest and highest quartiles was inpatient rehab ($2,169,
https://doi.org/10.1016/j.spinee.2019.05.495
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.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S158−S194
p=0.004), then skilled nursing facilities ($1,822, p=0.007) and home health ($785, p=0.007). CONCLUSIONS: Post-acute care, especially inpatient rehabilitation, is the primary driver of variation in 90-day episode payments for non-cervical spine fusions. Strategies for success in bundled payment initiatives will require attention to potentially discretionary use of post-acute care after index hospitalization. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
muscle health), 2 (adequate muscle health) and 3 (good muscle health). Higher scores corresponded to better VAS back (p=0.014), VAS leg (p=0.01), SF-12 PHS (0.027), ODI (p=0.022) and PROMIS (=0.001) scores. CONCLUSIONS: Muscle health contributes significantly to preoperative disability. When patients have combined low PL-CSA/BMI, goutallier classification and LIV this corresponds to significantly worse HRQOLs. This lumbar muscle health score is a valid screen for patients with poor muscle health which may be contributing to their disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
https://doi.org/10.1016/j.spinee.2019.05.496 https://doi.org/10.1016/j.spinee.2019.05.497 P73. A novel preoperative MRI-based lumbar muscle health calculation to predict patient-reported health-related quality of life scores Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Avani S. Vaishnav, MBBS1, Jung Mok, BS2, Steven J. McAnany, MD3, Sravisht Iyer, MD4, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Hospital for Special Surgery, Stamford, CT, US; 4 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: Poor lumbar muscle health has been implicated as a source of disability for patients with low back/radicular pain. We wanted to evaluate the relationship between muscle health and patient reported quality of life scores. PURPOSE: Determine how preoperative muscle health impacts patient reported health related quality of life scores. STUDY DESIGN/SETTING: Retrospective review of imaging and outcome scores. PATIENT SAMPLE: A total of 92 adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, paralumbar muscle cross sectional area (PL-CSA), lumbar indentation value (LIV), Goutallier classification. METHODS: We performed a retrospective review of patients that had lumbar decompression and/or fusion surgery after failing nonop management for degenerative pathologies. We quantified muscle health using PL-CSA, LIV and lumbar muscle fat atrophy using the Goutallier classification. T2 MRI axial slices from the disc space at the operative level were analyzed. We graded fat atrophy on a 1-4 scale and the LIV was calculated using a published technique of measuring the distance from the tip of a spinous process and a line across the muscular fascia. We used a standardized protocol of measuring cross sectional area of the paralumbar muscle (PL-CSA). We scaled the PLCSA by finding the ratio of PL-CSA/BMI. HRQOL scores collected included VAS leg, VAS back, ODI, SF-12 mental and physical health and PROMIS. We performed a linear regression analysis to determine the relationship of LIV, PL-CSA, PL-CSA/BMI and the HRQOLs. We performed an ANOVA analysis to identify the relationship between Goutallier classification and HRQOLs listed. We combined our measurements to create a score to quantify muscle health and determined whether this score correlated with HRQOLs based on an ANOVA analysis. RESULTS: A total of 92 patients were included within our analysis. The average age was 57.9+/-14.4 years old (49 men and 43 women). There were 104 levels operated on within this cohort. The most common preoperative diagnosis was lumbar spinal stenosis (58 patients). We found that the average LIV, PL-CSA and PL-CSA/BMI was 16.1 +/-7.5 mm, 4004 +/-1210 mm^2 and 153.5 +/- 45.0 mm^2/BMI. The PL-CSA/BMI ratio significantly correlated with preop SF-12 PHS (p = 0.03), VAS back (0.007) and VAS Leg (p = 0.002). Patients with less than 130 of the PL-CSA/BMI ratio had statistically significant worse PROMIS (35.9 vs 29.7, p=0.007), ODI (39.4 vs 50.2, p=0.01), SF-12 PHS (35.5 vs 28.7, =0.001), VAS leg (7.3 vs 5.5, p=0.007) and VAS back (7.9 vs 4.9, p=0.002) scores. We combined our results and scored each patient from 1-3 based upon whether there LIV <10mm or >10mm (0 or 1), Goutallier Classification >2 or <=2 (0 or 1) and whether PLCSA/BMI was >130 or <130 (0 or 1). Patients were stratified from 0-1 (poor
P74. Preoperative muscle health impacts the time taken to reach minimally clinically important differences in health-related quality of life scores for one-level lumbar fusions Sohrab Virk, MD1, Joshua Wright-Chisem, MD1, Jung Mok, BS2, Avani S. Vaishnav, MBBS1, Yahya A. Othman3, Steven J. McAnany, MD4, Sravisht Iyer, MD5, Todd J. Albert, MD2, Catherine Himo Gang, MPH2, Sheeraz A. Qureshi, MD, MBA2; 1 Hospital for Special Surgery, New York City, NY, US; 2 New York, US; 3 Weill Cornell Medicine, Qatar Foundation, Rayyan, Qatar; 4 Hospital for Special Surgery, Stamford, CT, US; 5 Rush University Medical Center, Chicago, IL, US BACKGROUND CONTEXT: There is evidence that degenerative changes in paralumbar musculature impact conditions like low back pain, and lumbar spinal stenosis. For patients undergoing spinal surgery we hypothesized that paralumbar muscle health would alter the time it took for patients to reach minimal clinically important differences (MCIDs) in health-related quality of life scores (HRQOLs). PURPOSE: Determine how preoperative muscle health impacts the time to MCID for one level MIS TLIF and/or decompression. STUDY DESIGN/SETTING: Retrospective review of a prospectively collected database PATIENT SAMPLE: Eighty-five adult patients with lumbar spine pathology requiring MIS lumbar decompression/fusion. OUTCOME MEASURES: Health-related-quality of life (HRQL) scores, lumbar indentation value (LIV). METHODS: We performed a retrospective review of patients that eventually went on to undergo either a lumbar decompressive surgery or a 1-level lumbar spinal fusion. We analyzed magnetic resonance imaging (MRI) to quantify muscle health using the lumbar indentation value (LIV) which is a validated method of measuring the relative cross-sectional area of lumbar musculature. T2 axial slices from the disc space at the operative level were analyzed. We separated our cohort of patients into whether they had a lumbar decompression alone or 1-level TLIF. Health related quality of life (HRQOL) scores were collected on these patients in the pre-operative period and the postoperative period up to 1 year out from surgery. These scores included the Visual analog back and leg scores (VAS leg and VAS back), the oswestry disability index (ODI), short form 12 (SF-12) mental health scores (MHS) and physical health scores (PHS). We defined MCID as has been previously reported in the literature. We then correlated the LIV calculated off preoperative MRI and correlated this finding with time to MCID using a linear regression analysis. RESULTS: A total of 85 patients were included within our analysis. The average age was 58.4+/-15.7 years old and there were 45 men and 40 women. There were 93 disc spaces operated on within this cohort. The majority of patients undergoing a lumbar decompression (LD) had a diagnosis of disc herniation (49.2%) and the majority of patients that had a lumbar fusion (LF) were diagnosed with lumbar spinal stenosis (93.1%). We found that the average LIV for LD patients was 16.2+/-6.5mm and for LF patients was 17.1+/-6.6mm. There was no statistically significant correlation between time to MCID for ODI, SF-12 MHS. SF-12 PHS, VAS leg, or VAS back scores and LIV for patients undergoing a lumbar decompression. There was a statistically significant inverse relationship between time to MCID for ODI (p =0.02) and LIV and time to MCID for SF-12 MHS
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.