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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

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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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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Correspondence to Mohammad Diab.

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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 (2022). https://doi.org/10.1007/s43390-022-00586-6

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  • DOI: https://doi.org/10.1007/s43390-022-00586-6

Keywords

  • Adolescent idiopathic scolosis
  • Posterior fusion
  • Anterior vertebral body tethering
  • Reoperation
  • Revisions
  • Direct costs