Evidence map›Paper›PMID 40159561›Full record

Observational studyNeurosurgical review2025

There is no "Value Penalty" for revision spine surgery: an application of the operative value index for primary versus revision lumbar fusions.

Advith Sarikonda, Steven Glener, D Mitchell Self, Danyal Quraishi, Ashmal Sami, Kavantissa M Keppetipola, Cheritesh R Amaravadi, Emily L Isch, Joshua Heller, Srinivas K Prasad and 6 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Neurosurgical review, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

16 authors.

Advith SarikondaDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA. Ays326@students.jefferson.edu.
Steven GlenerDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
D Mitchell SelfDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Danyal QuraishiDepartment of Surgery, Drexel University, Philadelphia, PA, USA.
Ashmal SamiDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Kavantissa M KeppetipolaDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Cheritesh R AmaravadiDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Emily L IschDepartment of General Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Joshua HellerDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Srinivas K PrasadDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Ashwini SharanDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Jack JalloDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Alexander R VaccaroDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA.
James HarropDepartment of Neurosurgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 909 Walnut Street, 2nd Floor, Philadelphia, PA, USA.
Nicholas ClarkHospital for Special Surgery at NCH, Naples, FL, Italy.
Ahilan SivaganesanHospital for Special Surgery at NCH, Naples, FL, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The increasing prevalence of elective lumbar fusions has been accompanied by a steady rise in revision procedures. Few studies have identified the relative cost-effectiveness of revision lumbar fusion using detailed costing methodology. Here, we aim to compare the "value" (outcomes achieved per dollar spent) of primary versus revision lumbar fusion by integrating time-driven activity-based costing (TDABC) with patient-reported outcomes (PROs). 292 patients were prospectively enrolled to undergo elective lumbar fusion. Revision surgery was defined as any case of lumbar fusion after a previous lumbar spine surgery. TDABC was employed to identify intraoperative costs for all cases. Oswestry Disability Index (ODI) scores were collected both preoperatively and at 6-months postoperatively. "Value" was measured through the Operative Value Index (OVI), defined as the percent improvement in ODI per $1,000 spent intraoperatively. Multivariable linear regression, accounting for confounders, was performed to assess whether revision surgery was significantly associated with total cost and OVI. Secondary analyses were performed to compare costs and OVI between primary fusions, revisions for prior decompression and fusion, and revisions for prior decompression alone. The average total cost of a revision fusion was $18,252 +/- $8,496, compared to $18,073 +/- $8,894 for a primary fusion. The average OVI for these groups were 1.79 and 1.65, respectively. On multivariable regression analysis, there were no significant differences in OVI (p = 0.423) or total cost (p = 0.841) between primary and revision cohorts.In the era of value-based care, it is increasingly important for hospitals to identify drivers of variation in the cost-effectiveness of neurosurgical care. By integrating PROs with detailed cost data, we demonstrate that revision lumbar fusions may not significantly differ in cost or value compared to primary fusions.

Indexed as

ReoperationSpinal FusionSpineAdultAgedAged, 80 and overCost-Effectiveness AnalysisElective Surgical ProceduresFemaleHealth Care CostsHumansLumbar VertebraeMaleMiddle AgedMultivariate AnalysisNeurosurgical ProceduresLumbar fusionOperative value indexOVIRevisionTDABC

Identifiers

PMID40159561

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.