Browsing by Author "Ogura, Yoji"

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    Cost-effectiveness of Surgical Treatment of Adult Spinal Deformity: Comparison of Posterior-only versus Antero-posterior Approach.
    (The spine journal : official journal of the North American Spine Society, 2020-04-11) Ogura, Yoji; Gum, Jeffrey L; Hostin, Richard A; Robinson, Chessie; Ames, Christopher P; Glassman, Steven D; Burton, Douglas C; Bess, R Shay; Shaffrey, Christopher I; Smith, Justin S; Yeramaneni, Samrat; Lafage, Virginie F; Protopsaltis, Themistocles; Passias, Peter G; Schwab, Frank J; Carreon, Leah Y; International Spine Study Group (ISSG)
    BACKGROUND CONTEXT:Considerable debate exists regarding the optimal surgical approach for adult spinal deformity (ASD). It remains unclear which approach, posterior-only or combined anterior-posterior (AP), is more cost-effective. Our goal is to determine the 2-year cost per quality-adjusted life year (QALY) for each approach. PURPOSE:To compare the 2-year cost-effectiveness of surgical treatment for ASD between the posterior-only approach and combined AP approach. STUDY DESIGN:Retrospective economic analysis of a prospective, multicenter database PATIENT SAMPLE: From a prospective, multicenter surgical database of ASD, patients undergoing 5 or more level fusions through a posterior-only or AP approach were identified and compared. METHODS:QALYs gained were determined using baseline, 1-year, and 2-year post-operative Short Form 6D. Cost was calculated from actual, direct hospital costs including any subsequent readmission or revision. Cost-effectiveness was determined using cost/QALY gained. RESULTS:The AP approach showed significantly higher index cost than the posterior-only approach ($84,329 vs $64,281). This margin decreased at 2-year follow-up with total costs of $89,824 and $73,904, respectively. QALYs gained at two years were similar with 0.21 and 0.17 in the posterior-only and the AP approaches, respectively. The cost/QALY at two years after surgery was significantly higher in the AP approach ($525,080) than in the posterior-only approach ($351,086). CONCLUSIONS:We assessed 2-year cost-effectiveness for the surgical treatment through posterior-only and AP approaches. The posterior-only approach is less expensive both for the index surgery and at 2-year follow-up. The QALY gained at 2-years was similar between the two approaches. Thus, posterior-only approach was more cost-effective than the AP approach under our study parameters. However, both approaches were not cost-effective at 2-year follow-up.
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    ItemOpen Access
    Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery.
    (Journal of neurosurgery. Spine, 2020-10) Ogura, Yoji; Gum, Jeffrey L; Soroceanu, Alex; Daniels, Alan H; Line, Breton; Protopsaltis, Themistocles; Hostin, Richard A; Passias, Peter G; Burton, Douglas C; Smith, Justin S; Shaffrey, Christopher I; Lafage, Virginie; Lafage, Renaud; Klineberg, Eric O; Kim, Han Jo; Harris, Andrew; Kebaish, Khaled; Schwab, Frank; Bess, Shay; Ames, Christopher P; Carreon, Leah Y; International Spine Study Group (ISSG)

    Objective

    The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.

    Methods

    From a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval.

    Results

    Of 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.6. Will I need another surgery? 25.0% will have a reoperation within 2 years.7. Will I regret having surgery? 6.5% would not choose the same treatment.8. Will I get a blood transfusion? 73.7% require a blood transfusion.9. How long will I stay in the hospital? You need to stay 8.1 days on average.10. Will I have to go to the ICU? 76.0% will have to go to the ICU.11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.12. Will I be taller after surgery? You will be 1.1 cm taller on average.

    Conclusions

    The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.