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Purpose <p>A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.</p> Methods <p>This prospective, multicenter study analyzed data from ASD patients with &gt; 4 levels of spinal fusion and a minimum 2-year follow-up. Index and total episode-of-care (EOC) costs in 2022 US dollars were calculated using average itemized direct costs obtained from administrative hospital records. Patients with total 2-year EOC cost &gt; 90th percentile were considered super-utilizers, the characteristics of which we identified through a multivariate generalized logistic model.</p> Results <p>Of 1299 eligible patients, mean age was 60&#xa0;years, 73% were female and 92% were Caucasian. Super-utilizers were older (+2.1&#xa0;years; <i>p</i> = 0.012), had greater depression (34.2 vs 25.7%; <i>p</i> = 0.03), increased frailty (<i>p</i> = 0.009) comorbidities (<i>p</i> = 0.005), higher reoperation rates (54.4 vs 15.0%; <i>p</i> &lt; 0.001), hospital length of stay (+ 3&#xa0;days; <i>p</i> &lt; 0.0001), higher surgical invasiveness (+28.6; <i>p</i> &lt; 0.001), more vertebrae fused (+ 3; <i>p</i> &lt; 0.0001); interbody fusions (80 vs 55%; <i>p</i> &lt; 0.0001), bone morphogenetic protein (BMP) use (87.3 vs 69.4%; <i>p</i> = 0.0001), operative time (+91&#xa0;min; <i>p</i> &lt; 0.0001), and blood loss (+620&#xa0;mL; <i>p</i> &lt; 0.0001) compared to other ASD patients. Index cost was 65% (<i>p</i> &lt; 0.0001), and cost/quality-adjusted life-year was three times higher among super-utilizers.</p> Conclusion <p>ASD patients with depression who undergo more complex or revision spinal surgical procedures are more likely to be super-utilizers. Identifying likely super-utilizers within the ASD population may enable targeted interventions and preoperative planning to reduce unnecessary costs, while improving patient outcomes.</p>

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Surgical invasiveness, reoperation, and preoperative depression are predictive of super-utilization in adult spinal deformity surgery

  • 期刊论文

  • 发表日期：

    2025年9月6日

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  • Pratibha Nayak,
  • Richard Hostin,
  • Jeffrey L. Gum,
  • Breton Line,
  • Shay Bess,
  • Lawrence G. Lenke,
  • Renaud Lafage,
  • Justin S. Smith,
  • Bassel Diebo,
  • Virginie Lafage,
  • Eric Klineberg,
  • Han Jo Kim,
  • Peter Passias,
  • Khal Kebaish,
  • Robert Eastlack,
  • Alan H. Daniels,
  • Gregory M. Mundis,
  • Themistocles S. Protopsaltis,
  • D. Kojo Hamilton,
  • Munish Gupta,
  • Frank J. Schwab,
  • Christopher I. Shaffrey,
  • Christopher P. Ames

摘要

Purpose

A subset of adult spinal deformity (ASD) patients undergoing corrective surgery receive a disproportionate level of medical resources and incur greater costs. We examined the characteristics of such super-utilizers of health care resources among ASD patients.

Methods

This prospective, multicenter study analyzed data from ASD patients with > 4 levels of spinal fusion and a minimum 2-year follow-up. Index and total episode-of-care (EOC) costs in 2022 US dollars were calculated using average itemized direct costs obtained from administrative hospital records. Patients with total 2-year EOC cost > 90th percentile were considered super-utilizers, the characteristics of which we identified through a multivariate generalized logistic model.

Results

Of 1299 eligible patients, mean age was 60 years, 73% were female and 92% were Caucasian. Super-utilizers were older (+2.1 years; p = 0.012), had greater depression (34.2 vs 25.7%; p = 0.03), increased frailty (p = 0.009) comorbidities (p = 0.005), higher reoperation rates (54.4 vs 15.0%; p < 0.001), hospital length of stay (+ 3 days; p < 0.0001), higher surgical invasiveness (+28.6; p < 0.001), more vertebrae fused (+ 3; p < 0.0001); interbody fusions (80 vs 55%; p < 0.0001), bone morphogenetic protein (BMP) use (87.3 vs 69.4%; p = 0.0001), operative time (+91 min; p < 0.0001), and blood loss (+620 mL; p < 0.0001) compared to other ASD patients. Index cost was 65% (p < 0.0001), and cost/quality-adjusted life-year was three times higher among super-utilizers.

Conclusion

ASD patients with depression who undergo more complex or revision spinal surgical procedures are more likely to be super-utilizers. Identifying likely super-utilizers within the ASD population may enable targeted interventions and preoperative planning to reduce unnecessary costs, while improving patient outcomes.