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. 2023 Nov 9:15:765-772.
doi: 10.2147/CEOR.S437202. eCollection 2023.

Estimating the Cost of Spinopelvic Complications After Adult Spinal Deformity Surgery

Scott L Zuckerman  1 , Daniel Cher  2 , Robyn Capobianco  2 , Daniel Sciubba  3 , David W Polly  4
Affiliations

Estimating the Cost of Spinopelvic Complications After Adult Spinal Deformity Surgery

Scott L Zuckerman et al. Clinicoecon Outcomes Res. .

Abstract

Objective: Reoperations for spinopelvic failure after adult spinal deformity (ASD) surgery are common. We sought to determine the added costs of ASD surgery attributable to reoperations for spinopelvic construct failures.

Methods: We constructed a Markov process model to calculate the expected discounted 5-year costs of spinopelvic construct failures after ASD surgery. The Nationwide Inpatient Sample (NIS) was queried to estimate the number of ASD surgeries. Model inputs were based on literature review and expert opinion. ASD surgery was defined as thoracolumbar fusion of 4 or more levels with pelvic fixation. The following pelvic fixation failures were included: 1) rod fracture or pseudarthrosis from L4-S1, 2) iliac screw failure or set plug dislodgment, 3) iliac screw prominence, and 4) sacroiliac (SI) joint pain. The number of patients undergoing ASD surgery annually in the US was determined using a commercial claims database.

Results: The net present value 5-year cost per patient for spinopelvic complications was $35,265, equal to 29% of index surgery costs. Given an estimated 27,580 cases annually in the US, the additional cost to address spinopelvic complications reach nearly $1 billion over 5-years. A sensitivity analysis showed that these costs were most sensitive to the rate of rod fracture/pseudarthrosis, iliac screw prominence, and reoperation.

Conclusion: A conservative estimate of the cost of spinopelvic failures after ASD surgery is substantial, nearly $1 billion over 5-years. We propose a method of capturing spinopelvic fixation failures for use in future clinical studies and cost analyses.

Keywords: deformity surgery; sacroiliac; spinopelvic.

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Conflict of interest statement

Dr Daniel Cher and Dr Robyn Capobianco are employees of SI-BONE. SI-BONE manufactures devices used in spine surgery. The manuscript does not discuss these devices. Dr Daniel Sciubba reports personal fees from DePuy, Medtronic, Stryker, Nuvasive, Baxter, and SI Bone, outside the submitted work. Dr David Polly reports personal fees from SI Bone and Globus, during the conduct of the study; grants from Medtronic and MizuhoOSI, outside the submitted work. In addition, Dr David Polly has patents US 11,571,245 B2. February 7, 2023, US 11,234,830 B2. February 1, 2022, and US 11,369,419 B2. June 28, 2022 with royalties paid to SI Bone. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient underwent T10-ilium PSIF. Two weeks postoperatively, he experienced acute onset of low back pain while getting up from chair. (A) PA and (B) lateral x-rays showed pullout of right rod from S2AI screw and set screw popped off from R S2AI screw. Of note, S1 screws are missing, which may have led to the acute iliac screw failure.
Figure 2
Figure 2
(A) PA and (B) lateral x-ray of patient who underwent T8-pelvis fusion and 2-years postoperatively experienced rod fracture at L4/5 on the left and pseudoarthrosis requiring reoperation. Of note, the right iliac set screw has also popped off.
Figure 3
Figure 3
(A and B) Patient who underwent a T5-ilium PSIF in 2013 with solid fusion. Nine years later she experienced prominence of her iliac instrumentation and skin breakdown. (C) Axial CT scan shows iliac screws close to the skin, with sagittal CT scans of the (D) right and (E) left screws eroding through the skin. The rods were cut proximal the screw, the screws were removed, and plastic surgery rotated paraspinal muscle flaps for closure. Of note, the unilateral left L3 rod fracture was asymptomatic.
Figure 4
Figure 4
(A) PA x-ray in patient who underwent lumbosacral deformity surgery showing radiolucency in the right iliac screw. (B) Enlarged view of the right iliac screw lucency. This patient developed sacroiliac joint (SIJ) pain that was improved with SIJ injections.
Figure 5
Figure 5
Tornado plot illustrating model sensitivities.
See this image and copyright information in PMC

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