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  • Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management: Analysis of 479 Patients with Minimum 2-year Follow-up

    Final Number:

    Justin K Scheer BS; Richard A. Hostin MD; Frank Schwab MD, PhD; Chessie Robinson MA; Virginie Lafage PhD; Douglas C. Burton MD; Robert Hart MD; Michael P Kelly MD; Malla Keefe; David W. Polly MD; Shay Bess MD; Christopher I. Shaffrey MD, FACS; Justin S. Smith MD, PhD; Christopher P. Ames MD; International Spine Study Group

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Operative management of ASD repeatedly demonstrates improvements in HRQOL over nonoperative treatment. However, little is reported regarding the quality-adjusted-life-year (QALY) improvements following surgical correction of ASD. The purpose of this study was to evaluate the QALY increases following the operative treatment of ASD compared with nonoperative treatment.

    Methods: Inclusion criteria: =18yrs, ASD. Health utility values were calculated from SF6D scores and used to calculate QALYs gained or lost at minimum 2 years from the baseline utility value. A subanalysis was conducted on the available patients in the cohort with complete 1, 2, and 3-year SF36 scores to establish a trend in QALY changes.

    Results: 365 op and 469 nonop patients were eligible for 2-year follow up and 479 patients were included (OP:258 (70.7%), NONOP:221(47.1%). OP had significantly worse health utility values (0.545±0.118 vs 0.657±0.114, p<0.0001), and larger QALY gained (0.139±0.253 vs -0.004±0.209, p<0.0001). OP had lower QALY at min 2ys (1.28±0.330 vs 1.39±0.374, p=0.0014). 179 patients (OP:106, NONOP:73) had complete 1,2, and 3yr SF36 scores and were included in the subanalysis. Of these patients, both groups had statistically similar mean QALYs at all time points (OP vs NONOP, p>0.05): 1yr (0.648±0.102 vs 0.645±0.090), 2yr (1.32 ±0.232 vs 1.27±0.204), and 3yr (1.97±0.379 vs 1.93±0.303). OP patients had a significantly larger increase in QALYs (from baseline) at 1, 2, and 3 years compared with NONOP (Figure): 1yr (0.084±0.113 vs 0.011±0.086, p<0.0001), 2yr (0.179±0.240 vs 0.005±0.186, p<0.0001), and 3yr (0.258±0.354 vs 0.020±0.258, p<0.0001).

    Conclusions: The operative treatment of adult spinal deformity results in significant increases in QALYs gained at minimum 2yrs postop as well as at the 1-, 2-, and 3-yr time points compared to nonoperative management.

    Patient Care: This will improve patient care by providing useful information for patients concerning operative vs. nonoperative treatment. This will aid in preoperative patient counseling and decision making.

    Learning Objectives: By the conclusion of this study, participants should be able to: 1) understand the significant increase in QALYs gained postoperatively for ASD patients compared with nonoperative treatment, 2) discuss the differences in outcomes for operative and nonoperative treatment.


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