For Some Patients, the Benefits of Intra-operative Neuromonitoring Might Not Outweigh the Costs


Newswise — NEW ORLEANS (April 29, 2013) — Researchers announced interesting findings during the 81st American Association of Neurological Surgeons (AANS) Annual Scientific Meeting regarding the value of intra-operative neuromonitoring (IOM) when comparing its use in influencing patient outcomes compared to the added cost it incurs. In fact, in the study titled Comparative Effectiveness, Cost Utility and Cost Benefit Analysis of Intra-Operative Neuromonitoring in Cervical Spine Surgery: Where is the Value?, presenting author Scott Parker, MD, along with co-authors Scott Zuckerman, MD; Saniya Godil, MD; Joseph Cheng, MD, MS, FAANS; Clinton Devin, MD; and Matthew McGirt, MD, found that in a real-world comparative effectiveness study of patients undergoing cervical spine surgery for degenerative spondylosis, IOM was associated with significant added cost without a corresponding benefit in safety or patient outcomes.

“This [study] highlights where you have to look deeper into the details to understand the type of treatment being conducted,” said study co-author Matthew McGirt, MD. “Different treatments can be of high value in some situations, and lack value in other situations. This is a lesson on how important it is to have clinical expertise and a focused look at value.” More detailed information and results from the study will be presented by Saniya Godil, MD, from 3:41-3:49 p.m. on Monday, April 29.

For the study, all patients undergoing cervical spine surgery for degenerative spondylosis were enrolled into a prospective registry. Data collected included demographics, treatment variables and 90-day surgical morbidity. Patient-reported outcomes (PRO), return to work and medical resource utilization were prospectively recorded at baseline and three months. CPT codes 95920 [baseline electrophysiologic testing (per hour)], 95295/95926 [SSEP], 95928/95929 [MEP] and 95937 [neuromuscular junction testing] were used to calculate the cost of IOM from a payer perspective. The cost of IOM per reduction in surgical morbidity (cost-benefit), and the difference in mean total cost per QALY-gained with IOM via incremental cost-effectiveness ratio [ICER] (cost-utility), were assessed.

A total of 180 patients underwent cervical surgery (102 with IOM, 78 without IOM), and baseline characteristics were similar between the two groups. IOM changes were only noted in four patients, and surgical strategy was only modified in one patient. There was no difference in 90-day morbidity and PROs improvement at three months between the two groups. The average added cost of IOM per patient was $1,208 (Medicare) and $2,053 (private payer) with no reduction in morbidity. The ICER for IOM versus not was $358,205/QALY.

The researchers concluded that, for certain low-risk cervical procedures with specific patient populations, IOM appears to be an area where cost can be saved without sacrificing surgical quality or patient safety. “Cost-effectiveness and value are going to be ever-more important as we go forward,” noted Dr. McGirt. “As physicians, we owe it to everybody, including our patients, to provide care in a sustainable way. We need to take a critical look at how we do that. IOM, we felt up front has a lot of value and a lot of importance, that allows us to do safe spinal surgery. IOM is a critical adjunct for a lot of different cases. And it’s important to note that these conclusions should not be extrapolated to high-risk spine surgeries such as spine tumors, trauma or deformity. But we looked at the lowest-risk population, at one specific subset of disease states, and did a traditional value analysis. We asked what the costs were that we put into the system, and based on evidence, our results showed this particular patient subset might allow us to cost-cut in a patient-centered way. It isn’t always about doing more — sometimes it’s about learning to do less.”

Disclosure: The author reported no conflicts of interest.

Media Representatives: The 2013 AANS Annual Meeting Press Kit includes releases on highlighted scientific research, AANS officer and award winners, National Neurosurgery Awareness Week, and other relevant information about this year’s program. Those releases also will be posted under the Media area on the 2013 AANS Annual Scientific Meeting website (http://www.aans.org/Annual Meeting/2013/Main/Media.aspx). If you have interest in a topic related to neurosurgery or would like to interview a neurosurgeon — either on-site or via telephone — during this year’s event, please contact John Iwanski, AANS Director of Member and Public Outreach, via the onsite press room at (504) 670-4910 or e-mail him at jai@aans.org.

About the 2013 AANS Annual Scientific Meeting: Attended by neurosurgeons, neurosurgical residents, medical students, neuroscience nurses, clinical specialists, physician assistants, allied health professionals and other medical professionals, the AANS Annual Scientific Meeting is the largest gathering of neurosurgeons in the nation, with an emphasis on the field’s latest research and technological advances. A record-breaking 1,003 scientific abstracts were presented for review at the 2013 AANS Annual Scientific Meeting, and the scientific presentations given at this year’s event represent cutting-edge examples of the incredible developments taking place within the field of neurosurgery. Additional information about the AANS Annual Scientific Meeting and the Meeting Program can be found at http://www.aans.org/Annual Meeting/2013/Main/Home.aspx.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 8,300 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.

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