• Richard Hostin, Chessie Robinson, Michael O'Brien, Christopher Ames, Frank Schwab, Justin S Smith, Virginie Lafage, Munish Gupta, Robert Hart, Douglas Burton, Shay Bess, Christopher Schaffrey, and Ian McCarthy.
• *Baylor Scott and White Health, Dallas †Baylor Scoliosis Center, Plano, TX ‡University of California San Francisco §NYU Hospital for Joint Diseases, New York, NY ¶University of Virginia, Charlottesville ||University of California at Davis, Sacramento **Oregon Health and Science University, Portland ††University of Kansas Medical Center, Kansas City ‡‡Rocky Mountain Hospital for Children, Denver, CO §§Department of Economics, Emory University, Atlanta, GA.
• Spine. 2016 Apr 1; 41 (7): 603-9.

Study DesignMulticenter, retrospective analysis, prospective database, consecutive case series.ObjectiveThis study examines multicenter variability in patient-level surgical resource use, including implants, biologics, and length of stay (LOS), alongside health-related quality-of-life (HRQoL) improvements after adult spinal deformity (ASD) surgery.Summary Of Background DataEfficiency in surgical resource use is critical to high-value health care. Decision makers and payers are placing increasing scrutiny on the costs and outcomes associated with complex spine surgery. Little is currently known regarding the variation in resources used and associated outcomes in complex spine surgeries.MethodsHRQoL outcomes were calculated from the Oswestry Disability Index, disease-specific 22-item Scoliosis Research Society questionnaire, and Medical Outcomes Study Short Form 36-question health survey domain scores. Changes in HRQoL were estimated as the difference between baseline and 2-year values. Patient-level surgical resources included blood use, bone morphogenetic protein volume, LOS, and implants. Patients were classified by mild, moderate, or severe sagittal modifier and analyzed across centers using analysis of variance and multivariable regression.ResultsWe analyzed 251 ASD patients, who were predominantly female (n = 207, 85%) with an average of 56 years (range 18-84 years). Significant differences were found in the average 2-year change in HRQoL across centers; however, this difference was found insignificant after controlling for patients within the same modifier groups (P > .05). However, significant differences were found across centers in average resources used per surgery (P < 0.05), with only LOS not reaching significance (P > 0.05). After accounting for clinical, demographic, and regional characteristics at the patient level, variation among centers persisted in resource use with no corresponding statistical differences in HRQoL outcomes.ConclusionThe use of additional surgical resources does not appear to impact 2-year HRQoL outcomes after surgery for ASD. The estimated impact of physician preference on surgical resource utilization highlights the variation in current surgical practice and the opportunity for cost reductions via a more standardized approach.Level Of Evidence3.

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