Original ArticleMetabolic Syndrome has a Negative Impact on Cost Utility Following Spine Surgery
Introduction
Metabolic syndrome (MetS) refers to a combination of medical disorders that increase the risk for multiple disease processes, including cardiovascular morbidity and mortality.1, 2, 3 Although there is no exact definition, the presence of obesity, hypertension, dyslipidemia, and diabetes are consensus components of the disease complex.4, 5, 6 There has been a rise in the prevalence of the MetS, with an estimated 25% to 33% of adults meeting criteria.7 In addition, MetS is a significant burden among older patients, as an analysis of US data from the cohort of the Framingham Offspring Study showed that the prevalence of MetS increased by approximately 50% from baseline at 50 years old, going from 21% to 34% in men and from 12.5% to 24% in women at 8 years of follow-up.8
MetS has been shown to negatively affect perioperative outcomes in spine surgery. In particular, MetS is associated with increased complications, readmissions, and length of stay compared to non-MetS patients.2,9 Because both the prevalence of spine surgery and MetS increase in parallel, there is a concern that outcomes may be compromised and expenditures increase among individuals with MetS. With increased pressure of pricing and cost transparency, improving the segmentation of cost analysis in spine surgery becomes crucial.
In this context, we sought to evaluate the total cost of surgery and cost per quality adjusted life years (QALYs) for spine fusion surgery patients. We hypothesized that MetS would be associated with more costly care and reduced cost-efficiency overall. Gaining a better understanding of the costs associated with MetS in spine surgery will allow for determination of cost-effectiveness of treating this population. Because the diseases encompassing MetS are objective and modifiable, these results contribute to the increasingly paramount discussion on cost efficiency and the potential utility of preoperative optimization. Therefore, with this shifting health care landscape, analyzing the costs associated with MetS in spine surgery can allow for improvements in surgical care.
Section snippets
Study Design and Data Source
This study was an institutional review board-approved retrospective review of patients presenting to a single academic spine center between November 2013 and November 2018. Inclusion criteria consisted of age >18 years, undergoing operative spine fusion surgery with available radiographic, surgical, and health-related quality of life data.
Patients were defined as having MetS based on the following criteria: body mass index (BMI) >30, diabetes mellitus, dyslipidemia (triglyceride levels ≥150
Patient Demographics
We included 312 patients in this analysis. The mean age of the cohort was 58.6 ± 12.7, 53% were female, and the mean BMI was 32.6 ± 6.4. A total of 24% of patients were cervical patients, 6% were thoracic, and 60% were lumbar surgery (Table 1).
Surgical Details
Surgical correction for these patients involved a mean 3.0 ± 3.4 levels fused, with 20% anterior approach, 65% undergoing a posterior approach, and 15% a combined approach. Mean operative time was 263.3 ± 135.7 minutes, mean estimated blood loss was 584.1
Discussion
MetS rates continue to rise in the general population, and as a result, the number of patients with MetS undergoing spine fusion surgery.2 The Centers for Medicare and Medicaid Services have increased legal and financial pressure on providers to reduce adverse outcomes after orthopedic surgery, highlighting the necessity to quantify the impact of MetS on complications, readmissions, length of stay, and cost efficiency.2,19,20 This investigation assessed the cost efficiency of treating spine
Conclusions
As the rates of MetS rise in both the general population and those undergoing spine fusion surgery, a better understanding of its effects on adverse outcomes and cost efficiency is necessary. This study found that MetS patients had higher total costs, and costs per QALY as compared with non-MetS patients. As the factors encompassing MetS are both clinically modifiable and objective, more research is needed on the potential role of preoperative optimization because it may reduce unnecessary
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Conflict of interest statement: P. G. Passias reports personal consulting fees for Spinewave, Zimmer Biomet, DePuy Synthes, and Medicrea outside the submitted work; other financial or material support from Allosource; research support from the Cervical Scoliosis Research Society; and as a paid presenter or speaker for Globus Medical. A. J. Buckland is a paid consultant for Nuvasive and Stryker.