Cervical Laminoplasty is Associated With Lower Health Care Costs as Compared With Cervical Fusion Procedures: A Systematic Review and Meta-analysis of Comparative Studies.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2024-11-01 DOI:10.1097/BSD.0000000000001711

Anthony N Baumann, Omkar Anaspure, Shiv Patel, Nazanin Kermanshahi, R Garrett Yoder, Keegan T Conry, Gordon Preston, Jacob C Hoffmann

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Abstract

Study design: Systematic review and meta-analysis.

Objective: The purpose of this study is to examine the cost of CLP versus CF stratified by approach to guide decision-making.

Summary of background data: Cervical laminoplasty (CLP) and cervical fusion (CF) are viable alternatives for surgical management of cervical spine myelopathy, with no clear consensus on clinical superiority. However, despite clinical equivalence in patient outcomes, there is limited data on the relative costs between CLP and CF.

Methods: This study searched PubMed, CINAHL, MEDLINE, and Web of Science databases. Inclusion criteria were articles that examined the cost between CLP and any type of CF (stratified by anterior, posterior, or combined approach). A random-effects continuous model for meta-analysis was performed using standardized mean difference (SMD).

Results: Eleven articles were included. Patients (n = 21,033) had an average age of 56.0 ± 3.6 years and underwent either CLP (n = 4364), posterior CF (n = 3529), anterior CF (n = 13,084), or combined CF (n = 56). The mean reported cost among patients who underwent CLP (n=3742) was significantly lower compared with patients who underwent CF (n = 6329), irrespective of the approach for CF (P = 0.028; SMD = -2.965). For subgroup analysis by surgical approach, the mean reported cost among patients treated with CLP was significantly lower as compared with patients treated with posterior CF (P = 0.013; SMD = -1.861) and anterior CF (P < 0.001; SMD = -0.344). Patients who underwent CLP had a significantly lower mean hardware cost than patients who underwent posterior CF (P < 0.001; SMD = -3.275).

Conclusions: CLP appears to be associated with statistically significant and clinically relevant lower reported costs than CF, irrespective of the approach based on meta-analysis of low or moderate-quality retrospective studies. CLP may also have lower reported costs than both posterior CF and anterior CF.

Level of evidence: IV.

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与颈椎融合术相比，颈椎板层成形术的医疗成本更低：比较研究的系统回顾和元分析》。

研究设计系统综述和荟萃分析：本研究的目的是按方法分层研究颈椎板层成形术（CLP）与颈椎融合术（CF）的成本，以指导决策：颈椎板成形术（CLP）和颈椎融合术（CF）是手术治疗颈椎脊髓病的可行替代方案，但临床疗效优劣尚未达成明确共识。然而，尽管患者的临床疗效相当，但有关CLP和CF相对成本的数据却很有限：本研究检索了 PubMed、CINAHL、MEDLINE 和 Web of Science 数据库。纳入标准为研究CLP与任何类型CF（按前路、后路或联合方法分层）之间成本的文章。使用标准化平均差（SMD）建立随机效应连续模型进行荟萃分析：结果：共纳入 11 篇文章。患者（n = 21,033）的平均年龄为（56.0 ± 3.6）岁，接受了CLP（n = 4364）、后路CF（n = 3529）、前路CF（n = 13,084）或联合CF（n = 56）。与接受 CF（n = 6329）的患者相比，无论采用哪种 CF 方法，接受 CLP（n = 3742）的患者报告的平均费用都显著较低（P = 0.028；SMD = -2.965）。在按手术方法进行的亚组分析中，接受CLP治疗的患者与接受后方CF（P = 0.013；SMD = -1.861 ）和前方CF（P < 0.001；SMD = -0.344）治疗的患者相比，报告的平均费用明显较低。接受CLP的患者的平均硬件成本明显低于接受后路CF的患者（P < 0.001; SMD = -3.275）：根据对低质量或中等质量回顾性研究的荟萃分析，无论采用哪种方法，CLP似乎都比CF的报告成本低，且具有显著的统计学意义和临床相关性。CLP的报告成本也可能低于后路CF和前路CF：证据等级：IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.