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Patient-Reported Outcomes and Costs Associated With Revision Surgery for Degenerative Cervical Spine Diseases

Kim, Elliott J., MD; Chotai, Silky, MD; Wick, Joseph B., BA; Stonko, David P., MS; Sivaganesan, Ahilan, MD; Devin, Clinton J., MD

doi: 10.1097/BRS.0000000000002361
OUTCOMES
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Study Design. A retrospective review of a prospective database.

Objective. The aim of this study was to determine cost and outcomes of revision cervical spine surgery.

Summary of Background Data. Revision rates for cervical spine surgery are steadily increasing. It is important to counsel patients on expected results following a revision procedure. However, outcomes and cost of these procedures are poorly defined in the literature.

Methods. Patients undergoing revision cervical spine surgery at a single institution were included between October 2010 and January 2016 in a prospective registry database. Patients were divided into three cohorts depending on their etiology for revision, including recurrent disease, pseudoarthrosis, or adjacent segment disease. Patient-reported outcomes (PROs), including Neck Disability Index (NDI), EuroQol-5D (EQ-5D), modified Japanese Orthopaedic Association (mJOA) score, numeric rating scale-neck pain (NRS-NP), and numeric rating scale-arm pain (NRS-AP), were measured at baseline and 12 months following revision surgery. Mean costs at 12 months following revision surgery were also calculated. Satisfaction was determined by the NASS patient satisfaction index. Variables were compared using Student t test.

Results. A total of 115 patients underwent cervical revision surgery for recurrent disease (n = 21), pseudoarthrosis (n = 45), and adjacent segment disease (n = 49). There was significant improvement in all patient-reported outcomes at 12 months following surgery regardless of etiology (P < 0.0001). Total cost of revision surgery ranged between 21,294 ± 8614 and 23,914 ± 15,396 depending on pathology. No significant differences were seen between costs among different revision groups (P = 0.53). Satisfaction was met in 75.5% to 85.7% (P = 0.21) of patients depending on the etiology of the revision need. Complication rates were between 4% and 9%.

Conclusion. This is one of the first studies to determine costs and outcome measures in the setting of cervical spine revision surgery. On the basis of our analysis, a majority of patients can expect to receive some benefit by 12 months and are satisfied with their procedure.

Level of Evidence: 4

Department of Orthopaedic Surgery and Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN.

Address correspondence and reprint requests to Clinton J. Devin, MD, Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774; E-mail: clinton.j.devin@vanderbilt.edu

Received 18 January, 2017

Revised 23 June, 2017

Accepted 19 July, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants, expert testimony.

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