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  • Healthcare Resource Utilization and Patient-reported Outcomes Following Elective Surgery for Intradural Extramedullary Spinal Tumors

    Final Number:

    Silky Chotai MD; Scott L. Zuckerman MD; Clinton J. Devin MD; Scott L. Parker MD; Joseph Wick; David P Stonko; Andrew Hale; Matthew J. McGirt MD; Joseph S. Cheng MD, MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Health-care resource utilization for intradural extramedullary spine tumors (IDEM) is not well reported. We set out to determine the resource utilization 12-month following surgical resection of IDEM tumors and compare the cost to a matched cohort of patients undergoing decompression with or without fusion for degenerative spine pathology

    Methods: Patients undergoing elective lumbar spine surgery and enrolled in a single center, prospective, longitudinal registry were analyzed. Baseline, post-operative 3-months, and 12-month PROs were recorded: Oswestry Disability Index (ODI) or Neck disability Index (NDI), EuroQol-5D (EQ-5D), numeric rating scale pain scores (NRS). One-year spine-related direct and indirect medical resource-utilization was assessed. One-year resource use was multiplied by unit costs based on Medicare national allowable payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). The PROs and costs associated with IDEM tumor surgery were compared to a propensity-matched cohort of patients with degenerative spine pathology

    Results: A total of 38 IDEM tumor patients matched with 38 degenerative spine pathology patients were included in this analysis. There was significant improvement in pain (BP, LP), disability (ODI) and quality of life (EQ-5D) in both age groups 12-month after surgery (P<0.0001). Mean direct cost was $23769±$8107 for fusion and $21323±$6430 without fusion surgery for IDEM spine tumor (P=0.31). Mean direct ($22,675±$7,412 vs. $19,581±$11,637, p=0.12) and total costs ($25,940±$9,314 vs. $22,217±$12,162, p=0.13) at 12-month following surgery for IDEM tumors were slightly higher compared to costs amongst those with degenerative spine diseases

    Conclusions: Surgical resection of the intradural extramedullary spine tumor provides improvement in patient-reported quality of life, general health, disability and pain at 12-month following surgery. The value of surgical resection of IDEM spine tumors is comparable, and within a threshold that is considered cost effective, to degenerative spine surgery from payers, providers, hospital and societal perspective

    Patient Care: The goal of surgery for IDEM tumors is complete resection with decompression of adjacent neural structures via the least invasive approach possible. However, in this current era of value-based health care it is important that the spine care providers understand the resource utilization associated with the spine tumor surgery.

    Learning Objectives: The literature on resource utilization for spine tumors surgery is sparse. We demonstrate the value of surgical resection of IDEM spine tumors is comparable to more benign degenerative spine surgery from payers, providers, hospital and societal perspective.


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