Metabolic Syndrome Has a Negative Impact on Cost Utility Following Spine Surgery.

December 26, 2019

OBJECTIVE:

Investigate the differences in spine surgery cost for metabolic syndrome patients.

METHODS:

Included: Patients ≥18, undergoing fusion. Patients were divided into cervical, thoracic, and lumbar groups based on their upper instrumented vertebrae (UIV). Metabolic syndrome patients (MetS) included: BMI >30, DM, dyslipidemia, and HTN. Propensity score matching for invasiveness between Non-MetS and MetS used to assess cost differences. Total surgery costs for MetS and non-MetS ASD patients were compared. QALYs and cost per QALY for UIV groups were calculated.

RESULTS:

312 invasiveness matched surgeries met inclusion criteria. Baseline demographics and surgical details: age 57.7 ± 14.5, 54% female, BMI 31.1 ± 6.6, 17% anterior approach, 70% posterior approach, 13% combined approach, 3.8 ± 4.1 levels fused. The average costs of surgery between MetS and non-Mets patients was $60,579.30 vs. $52,053.23 (p<0.05). When costs were compared between UIV groups, MetS patients had higher cervical and thoracic surgery costs ($23,203.43 vs $19,153.43, $75,230.05 vs. $65,746.16, all p<0.05) and lower lumbar costs ($31,775.64 vs. $42,643.37, p<0.05). However, the average cost per QALY at 1Y was $639,069.32 for MetS patients and $425,840.30 for non-Mets patients (p<0.05). At life expectancy, the cost per QALY was $45,456.83 vs. $26,026.84 (p<0.05).

CONCLUSIONS:

When matched by invasiveness, metabolic syndrome patients had an average 16.4% higher surgery costs, 50% higher costs per quality adjusted life years at 1 year, and 75% higher cost per quality adjusted life years at life expectancy. Further research is needed on the possible utility of reducing comorbidities in preoperative patients.