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Complication risks and costs associated with Ponte osteotomies in surgical treatment of adolescent idiopathic scoliosis: insights from a national database

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Abstract

Purpose

Risks of Ponte osteotomies (POs) used for posterior spinal fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS) are challenging to assess because of the rarity of complications. Using a national administrative claims database, we evaluated trends, costs and complications associated with PO used in PSF for AIS patients.

Methods

Using ICD-9/CPT codes, we identified patients (ages 10–18) with AIS who underwent PSF (± PO) between 2007 and 2015 in the IBM® MarketScan® Commercial Databases. Costs and trends of POs were evaluated. Odds of neurological complications and readmissions within 90 days and reoperations within 90 days and 2 years were assessed.

Results

We identified 8881 AIS patients who had undergone PSF, of which 8193 had 90-day follow-up and 4248 had 2-year follow-up. Overall, 28.8% had PO. Annual rate of POs increased from 17.3 to 35.2% from 2007 to 2015 (p < 0.001). Risk-adjusted multivariable logistic regression demonstrated no relationship between POs and neurologic complications (p = 0.543). POs were associated with higher odds for readmission (1.52 [1.21–1.91]; p < 0.001) and reoperation (2.03 [1.13–3.59]; p = 0.015) within 90 days, but there were no differences in the odds of reoperation within 2 years (p = 0.836). Median hospital costs were $15,854 (17.4%) higher for patients with POs (p < 0.001) and multivariable modeling demonstrated POs to be an independent predictor of increased costs (p < 0.001).

Conclusion

Annual rate of POs increased steadily from 2007 to 2015. POs were not associated with increased odds of neurological complications but had higher costs and higher rates of readmissions and reoperations within 90 days. By 2 years, differences in reoperation rate were not significant.

Level of evidence

III.

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Availability of data and material

The data that support the findings of this study are available from IBM® MarketScan® Commercial Databases but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the corresponding author upon reasonable request and with permission of IBM® Watson Health™.

Code availability

The code used for analysis will be shared upon reasonable request from the corresponding author.

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Acknowledgements

Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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This work did not receive any direct sources of funding.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Stanford University School of Medicine, 453 Quarry Rd, 3rd Floor, MC 5658, Palo Alto, CA, 94304, USA

    Mohammed Shaheen, Jayme C. B. Koltsov, Samuel A. Cohen, Joanna L. Langner, Japsimran Kaur, Nicole A. Segovia & John S. Vorhies

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  1. Mohammed Shaheen
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  2. Jayme C. B. Koltsov
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  3. Samuel A. Cohen
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  5. Japsimran Kaur
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  6. Nicole A. Segovia
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  7. John S. Vorhies
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Contributions

Mohammed Shaheen: data collection, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. Jayme C. B. Koltsov: data collection, data analysis, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. Samuel A. Cohen: data collection, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. Joanna L. Langner: data collection, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. Japsimran Kaur: data collection, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. Nicole A. Segovia: data collection, data analysis, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work. John S. Vorhies: data collection, writing-original draft preparation, and approval of final version of manuscript, agree to be accountable for the work.

Corresponding author

Correspondence to John S. Vorhies.

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Shaheen, M., Koltsov, J.C.B., Cohen, S.A. et al. Complication risks and costs associated with Ponte osteotomies in surgical treatment of adolescent idiopathic scoliosis: insights from a national database. Spine Deform 10, 1339–1348 (2022). https://doi.org/10.1007/s43390-022-00534-4

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