Document Type
Article
Publication Date
3-13-2025
Abstract
BACKGROUND: Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.
METHODS: We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion. Time-driven activity-based costing was used to calculate total intraoperative costs. Neck Disability Index (NDI) scores were recorded at baseline and 3 months postsurgery. Patients were categorized into groups based on their preoperative NDI score. Our primary outcome was a novel Operative Value Index (OVI), defined as the percent change in NDI per $1000 spent intraoperatively. Generalized linear mixed model regression was used to determine if severe-to-complete ("high") baseline neck disability was significantly associated with OVI and total cost.
RESULTS: Compared to patients with "high" preoperative neck disability, the OVI was significantly lower for patients with no neck disability (β-coefficient: -14.0; P < 0.001) and mild neck disability (β-coefficient: -4.06; P < 0.001). There were no significant associations between the NDI groups and total intraoperative cost.
CONCLUSIONS: Surgery provided the most value for patients with "high" baseline neck disability, with more favorable outcomes per dollar spent compared to those with low baseline neck disability. Patients with low baseline neck disability may therefore be suboptimal candidates for bundled payments, emphasizing the importance of careful patient selection to optimize resource use and outcomes in value-based care models.
Recommended Citation
Sarikonda, Advith; Sami, Ashmal; Self, D. Mitchell; Isch, Emily; Zavitsanos, Alexander; Fuleihan, Antony A.; Khan, Ayra; Dougherty, Conor; Quraishi, Danyal A.; Jallo, Jack; Heller, Joshua; Prasad, Srinivas K.; Sharan, Ashwini; Harrop, James; Vaccaro, Alex R.; and Sivaganesan, Ahilan, "Are Mildly Disabled Patients Appropriate for Spine Bundles? An Application of the Operative Value Index" (2025). Department of Neurosurgery Faculty Papers. Paper 251.
https://jdc.jefferson.edu/neurosurgeryfp/251
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
39983987
Language
English
Comments
This article is the author's final published version in World Neurosurgery, Volume 196, April 2025, Article number 123797.
The published version is available at https://doi.org/10.1016/j.wneu.2025.123797.
Copyright © 2025 The Author(s).