Evidence map›Paper›PMID 39090432›Full record

ArticleSpine deformity2024

Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions.

Andrew H Kim, Richard A Hostin, Samrat Yeramaneni, Jeffrey L Gum, Pratibha Nayak, Breton G Line, Shay Bess, Peter G Passias, D Kojo Hamilton, Munish C Gupta and 13 more

Abstract readComparative Study
PubMed Publisher
In one paragraph

Article in Spine deformity, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Andrew H KimDepartment of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St. 5th Floor, Baltimore, MD, 21205, USA.
Richard A HostinDepartment of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA.
Samrat YeramaneniDepartment of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA.
Jeffrey L GumNorton Leatherman Spine Center, Louisville, KY, USA.
Pratibha NayakDepartment of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA.
Breton G LineDenver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO, USA.
Shay BessDenver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke's Medical Center, Denver, CO, USA.
Peter G PassiasDepartment of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
D Kojo HamiltonDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Munish C GuptaDepartment of Orthopedic Surgery, Washington University, St. Louis, MO, USA.
Justin S SmithDepartment of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA.
Renaud LafageDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA.
Bassel G DieboDepartment of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Virginie LafageDepartment of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Eric O KlinebergDepartment of Orthopedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX, USA.
Alan H DanielsDepartment of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Themistocles S ProtopsaltisDepartment of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Frank J SchwabDepartment of Orthopedic Surgery, Lenox Hill Hospital, New York, NY, USA.
Christopher I ShaffreyDepartment of Neurosurgery and Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
Christopher P AmesDepartment of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA, USA.
Douglas C BurtonDepartment of Orthopedic Surgery, University of Kansas School of Medicine, Kansas City, KS, USA.
Khaled M KebaishDepartment of Orthopaedic Surgery, The Johns Hopkins University, 601 N Caroline St. 5th Floor, Baltimore, MD, 21205, USA. kkebais@jhmi.edu.ORCID 0000-0002-1235-6202
International Spine Study Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeAdult spinal deformity (ASD) patients with sagittal plane deformity (N) or structural lumbar/thoraco-lumbar (TL) curves can be treated with fusions stopping at the TL junction or extending to the upper thoracic (UT) spine. This study evaluates the impact on cost/cumulative quality-adjusted life year (QALY) in patients treated with TL vs UT fusion.

methodsASD patients with > 4-level fusion and 2-year follow-up were included. Index and total episode-of-care costs were estimated using average itemized direct costs obtained from hospital records. Cumulative QALY gained were calculated from preoperative to 2-year postoperative change in Short Form Six-Dimension (SF-6D) scores. The TL and UT groups comprised patients with upper instrumented vertebrae (UIV) at T9-T12 and T2-T5, respectively.

resultsOf 566 patients with type N or L curves, mean age was 63.2 ± 12.1 years, 72% were female and 93% Caucasians. Patients in the TL group had better sagittal vertical axis (7.3 ± 6.9 vs. 9.2 ± 8.1 cm, p = 0.01), lower surgical invasiveness (- 30; p < 0.001), and shorter OR time (- 35 min; p = 0.01). Index and total costs were 20% lower in the TL than in the UT group (p < 0.001). Cost/QALY was 65% lower (492,174.6 vs. 963,391.4), and 2-year QALY gain was 40% higher, in the TL than UT group (0.15 vs. 0.10; p = 0.02). Multivariate model showed TL fusions had lower total cost (p = 0.001) and higher QALY gain (p = 0.03) than UT fusions.

conclusionIn Schwab type N or L curves, TL fusions showed lower 2-year cost and improved QALY gain without increased reoperation rates or length of stay than UT fusions. LEVEL OF EVIDENCE: III.

Indexed as

Lumbar VertebraeQuality-Adjusted Life YearsSpinal FusionThoracic VertebraeAdultAgedCost-Benefit AnalysisFemaleFollow-Up StudiesHealth Care CostsHumansMaleMiddle AgedScoliosisTreatment OutcomeAdult spinal deformityCostQuality-adjusted life yearThoracolumbar fusionUpper thoracic fusion

Identifiers

PMID39090432

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.