Increasing Cost Efficiency in Adult Spinal Deformity Surgery: Identifying Predictors of Lower Total Costs

Peter G. Passias, Avery E. Brown, Cole Bortz, Haddy Alas, Katherine Pierce, Waleed Ahmad, Sara Naessig, Renaud Lafage, Virginie Lafage, Hamid Hassanzadeh, Lawal A. Labaran, Christopher Ames, Douglas C. Burton, Jeffrey Gum, Robert Hart, Richard Hostin, Khaled M. Kebaish, Brian J. Neuman, Shay Bess, Breton LineChristopher Shaffrey, Justin Smith, Frank Schwab, Eric Klineberg

Research output: Contribution to journalArticlepeer-review


Study Design.Retrospective study of a prospective multicenter database.Objective.The purpose of this study was to identify predictors of lower total surgery costs at 3 years for adult spinal deformity (ASD) patients.Summary of Background Data.ASD surgery involves complex deformity correction.Methods.Inclusion criteria: surgical ASD (scoliosis ≥20°, sagittal vertical axis [SVA] ≥5 cm, pelvic tilt ≥25°, or thoracic kyphosis ≥60°) patients >18 years. Total costs for surgery were calculated using the PearlDiver database. Cost per quality-adjusted life year was assessed. A Conditional Variable Importance Table used nonreplacement sampling set of 20,000 Conditional Inference trees to identify top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) SRS Schwab SVA grades.Results.Three hundred sixtee of 322 ASD patients met inclusion criteria. At 3-year follow up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. The average costs of surgery at 3 years was found to be $72,947.87, with no significant difference in costs between deformity groups (P > 0.05). There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, the top predictors of lower costs were frailty scores <0.19, baseline (BL) SRS Activity >1.5, BL Oswestry Disability Index <50 (all P < 0.05). For LSVA patients, no history of osteoporosis, SRS Activity scores >1.5, age <64, were the top predictors of lower costs (all P < 0.05). Among MSVA patients, ASD invasiveness scores <94.16, no past history of cancer, and frailty scores <0.3 trended toward lower total costs (P = 0.071, P = 0.210). For HSVA, no history of smoking and body mass index <27.8 trended toward lower costs (both P = 0.060).Conclusion.ASD surgery has the potential for improved cost efficiency, as costs ranged from $57,606.88 to $116,312.54. Predictors of lower costs included higher BL SRS activity, decreased frailty, and not having depression. Additionally, predictors of lower costs were identified for different BL deformity profiles, allowing for the optimization of cost efficiency for all patients.Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)21-26
Number of pages6
Issue number1
StatePublished - Jan 1 2022


  • adult spinal deformity
  • cost
  • cost efficiency
  • health economics
  • severity
  • spine surgery
  • value

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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