Satisfied patients have better outcomes, lower costs after revision ACDF

DALLAS – When patients expressed satisfaction after revision anterior cervical discectomy and fusion for adjacent segment disease, they scored far better outcome measurements and were less depressed than dissatisfied patients, according to a study presented at the North American Spine Society Annual Meeting, here.

“Satisfied patients did significantly better in regards to pain, disability, physical function and depression as compared to dissatisfied patients,” Katharine M. Burns, BS, who presented the study, said. “We found that diabetes has a profound adverse effect on patient satisfaction and may be used to predict postsurgical outcome. Overall, for satisfied patients, revision is a surgery that is cost effective and it provides a significant gain in quality of life.”

Burns and the researchers conducted a retrospective review of 40 patients undergoing revision anterior cervical discectomy and fusion for adjacent segment disease between 2000 and 2008. Patients completed satisfaction questionnaires over the phone. Outcome measurements included visual analog scale for neck pain and arm pain, EuroQol-5D health status index, short form 12 physical component score (SF-12 PCS) and mental component score, neck disability index and the Zung Depression Scale.

The researchers found 75% of patients were satisfied with their revision surgery at 2-year follow-up. The satisfied patients showed significantly better neck and arm pain scores and the SF-12 PCS score also improved the more the patient was satisfied. The dissatisfied patients expressed greater depression postoperatively. Furthermore, the researchers discovered a higher incidence of diabetes among dissatisfied patients.

Dissatisfied patients used health care resources more than satisfied patients. Lost wages added to the cost.

“What stands out is this massive discrepancy between the groups in regards to the costs for quality gained,” Burns said.

The increase of quality-adjusted life years (QALYs) for satisfied patients translated to a low overall cost for treatment of only $41,000 compared to more than $4 million for dissatisfied patients, who had a low gain in QALYs.

“Although the study population was small, we expect this population to grow at a considerable rate in the upcoming years,” Burns said. “We have been setting up a prospective database which has now grown to include over 1,500 patients and we believe the results of this study can provide valuable information for larger prospective studies in the future.”

Reference:

Burns KM. Paper #4. Presented at: North American Spine Society Annual Meeting; Oct. 24-27, 2012; Dallas.

Disclosure: Burns has no relevant financial disclosures.