A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden?
Autor: | Emre Acaroglu, Ahmet Alanay, Frank Kleinstück, Ferran Pellisé, Francesco Sanchez Perez Grueso, Aysun Çetinyürek Yavuz, Ümit Özgür Güler, Montse Domingo-Sabat, Ibrahim Obeid, Yasemin Yavuz, Selcen Yuksel |
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Rok vydání: | 2016 |
Předmět: |
Adult
Male medicine.medical_specialty Databases Factual genetic structures Health Status Alternative medicine Conservative Treatment Decision Support Techniques 03 medical and health sciences Life Expectancy 0302 clinical medicine Humans Medicine Orthopedic Procedures Orthopedics and Sports Medicine Kyphosis Disease burden Health related quality of life 030222 orthopedics Models Statistical business.industry Public health Non surgical treatment Middle Aged Decompression Surgical humanities Osteotomy Surgery Spinal Fusion Treatment Outcome Quality of Life Spinal deformity Female Neurosurgery business 030217 neurology & neurosurgery Decision analysis |
Zdroj: | European Spine Journal. 25:2390-2400 |
ISSN: | 1432-0932 0940-6719 |
Popis: | Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality.To construct a statistical DA model to identify the optimum overall treatment in ASD.From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical-NS, 164 surgical-S), constitute the population of this study. DA was structured in two main steps of: (1) baseline analysis (assessing the probabilities of outcomes, assessing the values of preference-utilities-, combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and (2) sensitivity analysis.Four hundred and thirty-two patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1 %) were found to be improved (a decrease in ODI 8 points), 225 (52.1 %) unchanged (-8 ODI 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2 %) versus NS (9.7 %). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final QALE in the NS group (60 vs. 65, P = 0.0038), this group having started with higher QALE as well (56 vs. 65 years, P 0.0001). There were improvements in overall QALE in both groups but this was significant only in the surgical group (S from 56 to 60 years, P 0.0001; NS from 65 to 65 years, P = 0.27). In addition, in the subgroup of patients with significant baseline disability (ODI 25) surgery appeared to yield marginally better final QALE (58 vs. 56 years, P = 0.1) despite very a similar baseline (54 vs. 54 years, P = 0.93).This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6 %) QALE compared to surgery, most probably secondary to a higher baseline QALE. On the other hand, surgery provides a significantly higher increase in QALE. Especially in patients with significant disability at baseline, the final QALE tended higher in the S group (although not significant). Finally, chances of a relevant improvement at first year turned out to be significantly lower with NS treatment. |
Databáze: | OpenAIRE |
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