Preoperative optimization may improve outcomes, cost utility of cervical deformity surgery
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Key takeaways:
- Optimization prior to spinal deformity corrective surgery may improve outcomes, satisfaction and cost utilization.
- Surgeons may consider prescribing cognitive behavioral therapy for mental health optimization.
Preoperative patient optimization prior to adult spinal deformity corrective surgery may improve outcomes, satisfaction and cost utilization, according to presented results.
“Surgical interventions become commonplace for [patients with adult spinal deformity] when indicated, but there's a lot of planning that goes into these surgeries including preoperative optimization, as well as medical assessment [and] diagnostic imaging,” Peter G. Passias, MD, said during his presentation at the North American Spine Society Annual Meeting. “There is a mind-body connection. Anxiety and depression have been strongly associated with back and muscle pain, and chronic pain has been accompanied by significant functional limitations,” he added.
Passias and colleagues at NYU Langone Health performed a retrospective cohort study of data from 47 patients (mean age of 53.6 years) who underwent adult spinal deformity corrective surgery.
According to the abstract, patients completed four validated self-report instruments: distress and risk assessment method (DRAM), fear-avoidance beliefs questionnaire (FABQ), pain catastrophizing scale (PCS) and outcome expectation question (OEQ). Passias and colleagues found 57.1% of patients had a severe FABQ score, 40.8% had a severe PCS score and 27.7% had a severe neck disability index (NDI).
Patients who did not meet thresholds were assigned to a control group (n = 10). Patients who met the thresholds were assigned to either a sham group (n = 11), which received six sham treatments prior to surgery, or a cognitive behavioral therapy (CBT) group (n = 17), which received treatment by a licensed professional prior to surgery. Patients who exceeded psychological distress criteria were assigned to a DRAM observation-only group (n = 9).
Outcome measures included functional outcomes and patient satisfaction, as well as costs, quality-adjusted life-years (QALYs) and costs per QALY to determine cost utility.
Overall, 33 patients (68.8%) had complete follow-up at 2 years. Total utility gained was the greatest in the DRAM group (0.467) compared with the sham (0.371), CBT (0.351) and control (0.235) groups. Passias and colleagues found patients in the control group had the lowest cost-effectiveness ($11,274) compared with patients in the sham ($7,224), CBT ($7,043) and DRAM ($6,024) groups. Passias notes patients who received CBT had the highest rate of improvement in functional outcomes such as PCS, FABQ and NDI.
“The present study demonstrated an increased rate of mental health-related disabilities associated with diminished clinical outcomes and cost-effectiveness for cervical deformity surgery, and there may be a role for preoperative optimization,” Passias concluded.
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Passias PG, et al. Paper 129. Presented at: North American Spine Society Annual Meeting; Oct. 18-21, 2023; Los Angeles.
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