137. The impact of delayed surgical intervention for cervical deformity on patient recovery and cost effectiveness

Abstract

<h3>BACKGROUND CONTEXT</h3> Surgical correction of cervical deformity is a proven treatment option that provides functional restoration and pain relief. It is unclear whether patient outcomes and costs of the procedure are influenced by the time between initial symptom onset and definitive surgical intervention. This study sought to determine how long nonoperative treatment should be exhausted prior to offering surgery for cervical deformity. <h3>PURPOSE</h3> To identify whether delayed procedures influence patients' ability to recover and cervical deforminty corrective surgery cost effectiveness. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort. <h3>PATIENT SAMPLE</h3> This study included 290 cervical deformity patients. <h3>OUTCOME MEASURES</h3> Delayed surgical intervention, recovery kinetics, cost effectiveness. <h3>METHODS</h3> Cervical deformity patients with baseline (BL) and two-year (2Y) follow-up data were included. Patients were stratified by time to surgery following the onset of their neck pain: >5 years=Delayed; <5 years=not Delayed. Normalized HRQL scores at BL and follow-up intervals (3M, 6M, 1Y, 2Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State [IHS]). Cost was calculated using the PearlDiver database, which represents national average Medicare cost. Cost per Quality-Adjusted Life Year (QALY) at 2Y was calculated. Multivariable regression analysis assessed the impact of Delayed surgery on patient outcomes and cost. <h3>RESULTS</h3> A total of 123 patients were included (54 Delayed, 69 not Delayed). Demographic and surgical characteristics were similar between groups (p > 0.05). Normalized HRQLs showed that Delayed patients exhibit worse NDI and NRS Neck at 2Y follow-up, both p 0.05. Utility gained at 2Y follow-up was 0.172 for Delayed and 0.2847 for not Delayed. This translated to QALY gained at 2Y of 0.334 for Delayed and 0.553 for not Delayed, p 0.05. Multivariable analysis found Delayed patients were less likely to gain utility (OR 0.125 [CI 0.019-0.840]) and QALYs (OR 0.343 [CI 0.129-0.914]) at 2Y postoperatively, both p< 0.05. <h3>CONCLUSIONS</h3> Patients who had a 5-year or greater delay to surgery from the onset of neck pain had more significant postoperative neck disability. Cost by procedure and cost-effectiveness when stratified by time to surgery following enrollment were comparable. While both patient cohorts had postop improvement, patients without delay had greater utility gained and quality adjusted life years at 2-year follow-up. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.