What Is the Value Proposition of Evidence-Based Guidelines? An Application of the Operative Value Index for Lumbar Fusions.
Publication/Presentation Date
9-1-2024
Abstract
BACKGROUND: Elective lumbar fusions have received criticism for inappropriate utilization. Here, we use a novel Operative Value Index (OVI) to assess whether "indicated," evidence-based lumbar fusions are associated with increased value (outcomes per dollar spent).
METHODS: This study is a retrospective analysis of a prospective observational cohort of 294 patients undergoing elective lumbar fusions at a single large academic institution. All patients were preoperatively evaluated by a panel of neurosurgeons for concordance with evidence-based medicine (EBM), determined through guidelines from the North American Spine Society. Oswestry Disability Index (ODI) scores were collected for all patients both preoperatively and at 6-months postoperatively. Time-driven activity-based costing was employed to determine both direct and indirect intraoperative costs. The OVI was defined as the percent improvement in ODI per $1000 spent intraoperatively. Generalized linear mixed model regression, adjusting for confounders, was performed to assess whether EBM-concordant surgeries were associated with higher OVI.
RESULTS: Of 294 elective lumbar fusions, 92.9% (n = 273) were EBM-concordant. The average total cost of an EBM-concordant lumbar fusion was $17,932 (supplies: $13,020; personnel: $4314), compared to $20,616 (supplies: $15,467; personnel: $4758) for an EBM-discordant fusion. Average OVI was 2.27 for a concordant fusion, compared to 0.11 for a discordant fusion. Generalized linear mixed model analysis revealed that EBM-concordant cases were associated with significantly higher OVI (β-coefficient 2.0, P < 0.001).
CONCLUSIONS: EBM-concordant fusions were associated with 2% greater improvement in ODI scores from baseline for every $1000 spent intraoperatively. Systematic methods for increasing guideline adherence for lumbar fusions could therefore improve value at scale.
Volume
189
First Page
832
Last Page
832
ISSN
1878-8769
Published In/Presented At
Sarikonda, A., Sami, A., Hines, K., Self, D. M., Isch, E., Leibold, A., Keppetipola, K. M., Gonzalez, G., Mansoor Ali, D., Thalheimer, S., Heller, J., Prasad, S., Jallo, J., Sharan, A., Vaccaro, A. R., Harrop, J., & Sivaganesan, A. (2024). What Is the Value Proposition of Evidence-Based Guidelines? An Application of the Operative Value Index for Lumbar Fusions. World neurosurgery, 189, e832–e840. https://doi.org/10.1016/j.wneu.2024.07.015
Disciplines
Medicine and Health Sciences
PubMedID
38977127
Department(s)
Department of Surgery
Document Type
Article