Logo image
Back
Should Proximal Fixation be at C2 or C3-C4? An Application of the Operative Value Index for Elective Posterior Cervical Decompression and Fusion
Journal article   Open access   Peer reviewed

Should Proximal Fixation be at C2 or C3-C4? An Application of the Operative Value Index for Elective Posterior Cervical Decompression and Fusion

Advith Sarikonda, D. Mitchell Self, Danyal Quraishi, Ashmal Sami, Emily L. Isch, Steven Glener, Joshua Heller, Srinivas Prasad, Ashwini Sharan, Jack Jallo, …
World neurosurgery, v 197, 123898
01 May 2025
DOI: https://doi.org/10.1016/j.wneu.2025.123898
PMID: 40090409
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.wneu.2025.123898View
Published, Version of Record (VoR) Open

Abstract

Intraoperative costs Operative value index (OVI) Posterior cervical decompression and fusion (PCDF) Proximal axial instrumentation Subaxial instrumentation Time-driven activity-based costing (TDABC) Upper instrumented vertebrae (UIV) Value-based healthcare
There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true “value” (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed. We retrospectively identified 275 long-segment (≥3-levels fused) PCDFs with available Neck Disability Index (NDI) scores at baseline and at 3 months postoperatively. C2 UIV (n = 67) was compared to C3/C4 UIV (n = 208). Time-driven activity-based costing was applied to identify the true intraoperative costs for each case. The Operative Value Index (OVI) was defined as the percent improvement in NDI score from baseline, per $1000 spent intraoperatively. Multivariable regression analysis was performed to compare intraoperative costs and OVI between C2 and C3/C4 UIV. The average total cost of a C2 construct was $13,751 ($5247), compared with $10,778 ($2237) for C3/C4 (P < 0.001). Forty percent of C2 cases and 32% of C3/C4 cases, respectively, achieved clinically significant improvement in NDI. On multivariable regression analysis, C2 UIV was associated with significantly higher total cost (beta-coefficient: $1814 ± 553, P = 0.001), supply cost (beta-coefficient: $1185 ± $482, P = 0.015) and personnel cost (beta-coefficient: $275 ± $116, P = 0.019). However, there was no significant difference in OVI (P = 0.155) between C2 and C3/C4 UIV. Although the C2 UIV construct incurred significantly higher intraoperative costs compared with C3/C4 UIV, there was no significant difference in “value” between axial and subaxial UIV.

Metrics

1 Record Views
4 citations in Web of Science

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

Source: SDGs in the Output

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Surgery
Logo image