In the first 5 years of Treatment, the Charges for Guided Growth Constructs are 30% less than Growing Rods Lindsay M. Andras MD 1, Liam Harris BS 1, Scott.

Slides:

Advertisements

Similar presentations

The Safety and Effectiveness of Convex Anterior and Posterior Hemiepiphysiodesis for the Treatment of Congenital Scoliosis Andrew Thome, Jr. 1, Roshan.

Advertisements

E-Poster #510 Mineralized Collagen and Bone Marrow Aspirate in Anterior Interbody Carbon Fiber Cages Achieve High Fusion Rates in Multilevel Adult Spinal.

F Schwab 1,2, JP Farcy 1,2, K Bridwell 2, S Berven 2, S Glassman 2,

Surgery of Spinal Deformities Rizzoli Orthopaedic Institute Bologna, Italy Surgical options in progressive scoliosis in pediatric patients with Neurofibromatosis.

Fusionless Correction for Early Onset Scoliosis (EOS) Emma Orton BME 281.

Comparison of the Volume of Scoliosis Surgery Between Spine and Pediatric Orthopaedic Fellowship-Trained Surgeons in New York and California by Mark A.

Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized commercial reproduction of this slide is prohibited Supplemental PowerPoint Slides Prediction.

Jason B. Anari, MD. ; Sumeet Garg, MD#; Peter F. Sturm, MD&; Patrick J

Thoracogenic Spinal Deformity: A Rare Cause of Early Onset Scoliosis International Congress on Early Onset Scoliosis November 19 & 20, 2015 A. Noelle Larson,

Cincinnati Children’s Hospital Medical Center

A Comparison of Patients Treated with Shilla Growing Rods for Early Onset Scoliosis 9 th International Congress on Early Onset Scoliosis November 19-20,

Patients without intraoperative neuromonitoring (IONM) alerts during implantation of rib based growing constructs did not sustain neurologic injury during.

Growth Preserving Spinal Surgery for Scoliosis in Children with Osteogenesis Imperfecta Lawrence Karlin, MD, Amer Samdani, MD, Anna McClung, BSN, RN, Michael.

Comparison of deformity correction and complications with VEPTR and early primary posterior spinal fusion in young children with idiopathic scoliosis:

Short Term Health Related Quality of Life and Family Burden after Surgical or Casting Treatment Hiroko Matsumoto, Nicholas Feinberg, Julie Yoshimachi,

A minimum of 2 year follow up of 22 EOS patients who were treated with 2 nd generation MCGR Karsten Ridderbusch, Christian Hagemann, Ralf Stücker Childrens.

Intra-wound Vancomycin Powder Significantly Reduces the Risk of Infection in Growth-friendly Surgery John T. Smith, MD Justin Haller, MD Angela Presson,

John T. Wilkinson m. d. , Chad E. Songy m. d. , Frances l

The Use of MAGEC Growing Rods as a temporary distraction rod in Severe Kyphoscoliosis: A Case Report. John T. Smith, MD Mary Scowcroft Perry Presidential.

K O B E U N I V E R S I T Y O R T H O P E D I C S A K O B E U N I V E R S I T Y O R T H O P E D I C S A Nippon Steel Hirohata Hospital Nippon Steel Hirohata.

Authors: Pooria Hosseini MD, Jeff Pawelek BS, Gregory Mundis MD, Burt Yazsay MD, John Ferguson MD, Ilkka Helenius MD, Kenneth Cheung MD, Gokhan Demirkiran.

ICEOS 2015 Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis Liam Harris BS1, Lindsay M Andras MD1, Paul D.

Incidence of Proximal junctional kyphosis with Magnetic Expansion Control Rods in early onset scoliosis P Inaparthy, JC Queruz, C Thakar, D Rolton, C Nnadi.

The Rib Construct (RC) has provided secure proximal fixation for management of patients with EOS and severe thoracic hyperkyphosis Alaa Azmi Ahmad – MD.

Final Fusion in Patients Treated with Rib Based Distraction: A Review of Peri- operative Results THE UNIVERSITY OF UTAH Department of Orthopaedic Surgery.

Burt Yaszay, MD Jeff B. Pawelek, BS John Emans, MD Patrick Cahill, MD Bo Robertson Gregory M. Mundis, MD Behrooz A. Akbarnia, MD Children’s Spine Study.

Authors: Pooria Hosseini MD MSc, Jeff Pawelek BS, Stacie Nguyen MPH, George H. Thompson MD, Suken A. Shah MD, John M. Flynn MD, John P. Dormans MD, Behrooz.

Does posterior fusion prevent parasol deformity of the chest in inmature patients (Risser sign 0 and open triradiate cartilage of pelvis) with MSA type.

Xingye Li, Jianxiong Shen, M.D.

Swamy Kurra Stephen Albanese Patrick Cahill Randal Betz

Prospective clinical study of spine growth modulation using

ICEOS 2016 Pelvic obliquity correction in distraction based growing spine constructs Mathew Schur BA1, Lindsay M Andras MD1, Nicholas R Gonsalves MD1,

Adam Margalit, BS Paul D. Sponseller, MD Richard McCarthy, MD

ICEOS 2016 Utrecht, November 2016

ICEOS 2016 Comparison of Weight Percentile Gain with Growth-Friendly Constructs in Early Onset Scoliosis Liam Harris BS1, Lindsay M Andras MD1, Paul D.

How is definitive treatment effective in early onset scoliosis treated with Growing implants? Review of one centre series Tiziana Greggi, Elena Maredi,

DISCREPANCY BETWEEN PROGRAMMED AND OBSERVED DISTRACTIONS IN MAGNETICALLY-CONTROLLED GROWING ROD TREATED PATIENTS María del Mar Pozo-Balado, PhD; Noelia.

Retrospective Review of Shoulder Balance Comparing Adolescent Idiopathic Scoliosis (AIS) to Early Onset Scoliosis (EOS) Patrick J. Cahill William Lavelle.

Traditional Growing Rod Instrumentation: Risk-Benefit Analysis of Surgical Intervention Christopher Migdal, BS,1,2 Eric Klineberg, MD,1,2 Joel Lerman,

Sumeet Garg, MD Jack Flynn, MD Nicole Michael, BA

Nicole Michael, BA John Smith, MD Tricia St. Hilaire, MPH

Children’s National Health System ICEOS 2016 – Utrecht, Holland

PELVIC OBLIQUITY CONTROL IN CHILDREN WITH NEUROMUSCULAR EARLY ONSET SCOLIOSIS TREATED WITH MAGNETICALLY-CONTROLLED GROWING RODS María del Mar Pozo-Balado,

Richard Schwend, MD Robert Tung, BS Division of Orthopedic Surgery

Brian Yang BA, Jill Larson MD, Michael Glotzbecker MD

Distraction-Based Surgeries Increase Spine Length for Patients with Non-Idiopathic EOS - 5 Year Follow up Yehia ElBromboly, Jennifer Hurry, Kedar Padhye,

O C Shirley, A Field, A Barrie, J Ferguson

Michael J. Elliott,MD; Jesua Law, DO

The Use of MAGEC Growing Rods as a temporary distraction rod in Severe Kyphoscoliosis: 2 Case Reports. John T. Smith, MD Mary Scowcroft Perry Presidential.

Early Experience of Frequent Small Increments Lengthening of Magnetic Spinal Growing Rods in Children with Severe Early Onset Scoliosis Joseph Ivan Krajbich.

Hospital Universitario La Paz, Madrid, Spain

Does rod orientation and use of cross connector affect spinal height in magnetically controlled growing rod patients? Pooria Hosseini, Behrooz A. Akbarnia,

Magnetically Controlled Growing Rods: Sagittal Plane Analysis and the Risk of Proximal Junctional Kyphosis Purnendu Gupta, Felix Brassard, Jennifer Schottler,

Sara K. Fuhrhop, BS Mark J. McElroy, MS Harry C. Dietz, MD

Outcome Measures in Early Onset Scoliosis

Charles E. Johnston, MD Anna McClung BSN, RN Scott Paradise

Complications of Anchors in the Growing Rod Technique

Dual Rods and Submuscular Rod Placement Reduce Complications and Unplanned Surgeries in the Growing Spine: Analysis of 910 Surgeries in 143 Patients Shay.

Behrooz A. Akbarnia Nima Kabirian Jeff Pawelek Milad Alam

Preliminary Results using Shilla guided growing rods with sublaminar fixation in Early Onset Scoliosis Samuel R. Rosenfeld, M.D. Benjamin T. Smith, D.O.

John A Heflin, MD John T. Smith, MD

M. Bulent Balioglu, Y. Emre Akman, Yunus Atici,

Classification of EOS Treatment

Sumeet Garg, MD The Children’s Hospital, Colorado

Nicholas D. Fletcher, MD¹ Charles E. Johnston III, MD²

HAZEM B ELSEBAIE FRCS, MD

Suken A. Shah, MD Jon Oda, MD William Mackenzie, MD

Simultaneous Vertebral Column Resection (VCR) and Growing Rods (GR) or Shilla for Severe Early Onset Spinal Deformity (EOS) John Emans, MD; Ashley Goldthwait,

Management of Implant Related Infections:

Presentation transcript:

In the first 5 years of Treatment, the Charges for Guided Growth Constructs are 30% less than Growing Rods Lindsay M. Andras MD 1, Liam Harris BS 1, Scott Yang MD 1, Alexander Broom BA 1, Howard Park MD 2, McKenna Archer MS 1, David L. Skaggs MD MMM 1 1.Children’s Orthopaedic Center, Children's Hospital Los Angeles, 2.Orthopaedics, University of California Los Angeles 1 ICEOS 2015

Disclosures Lindsay M. Andras MD – Eli Lilly (c); Orthobullets (e) Liam Harris BS - None Scott Yang MD – None Alexander Broom BA – None Howard Park MD – None McKenna Archer MS – None David L. Skaggs MD MMM – – SRS & POSNA (a); Biomet; Medtronic; Orthobullets; Grand Rounds (b); Zipline Medical, Inc. (b & c); Biomet; Medtronic; Johnson & Johnson (d); Wolters Kluwer Health - Lippincott Williams & Wilkins; Biomet Spine (e) 2 a.Grants/Research Support b.Consultant c.Stock/Shareholder d.Speakers’ Bureau e.Other Financial Support

Background Growing rod (GR) instrumentation and guided growth constructs are two alternatives for treatment of severe progressive early onset scoliosis (EOS) Unlike growing rod instrumentation, guided growth constructs do not require routine surgical lengthenings No prior studies have compared the economics of these two alternative treatments for severe EOS 3

Objective To investigate the economics of growing rod versus guided growth constructs for the treatment of early onset scoliosis 4 Screws that the rod can slide along Limited fusion at apex to control curve Connectors through which the rods are lengthened Growing Rods Guided Growth Construct

Methods Retrospective chart review of EOS patients at a single institution from 2007 to 2014 with either GR or guided growth constructs Patients with less than 2 year follow up were excluded Physician and hospital charges and collections until most recent follow up or time of definitive fusion were examined The charges were averaged per patient Statistical significance analyzed via t-test 5

Results 18 patients met the inclusion criteria: GR group - 7 patients Guided growth construct group - 11 patients No significant difference in age at instrumentation, preoperative major curve or length of follow up between the two groups 6 Mean Age of Index Instrumentation Mean Major Preoperative Curve Mean Length of Follow up Growing Rods4.8 yrs 83.6° 4.9 yrs Guided Growth Construct 5.9 yrs 76.5° 4.7 yrs P-Value

Results Mean number of procedures excluding final fusion GR Group: 6.0 procedures Guided Growth Construct Group: 2.1 procedures The mean physician charges, physician collections, and hospital charges were significantly less for the guided growth constructs. 7 Mean Physician Charges Mean Physician Collection Mean Hospital Charges Mean Hospital Collections Growing Rods$52,152$13,438$204,087$52,149 Guided Growth Constructs $21,371$4,871$159,509$30,952 P-Value<

Results Mean charges and collections per patient: 8

Discussion The smaller number of procedures in the guided growth construct group corresponded to significantly lower physician charges, physician collections, and hospital charges compared to GR group Prior research has demonstrated that GR provide slightly more curve correction and increase in T1-S1 length with intermediate follow up than guided growth constructs 5 However, this has to be weighed against the cost both to the healthcare system and to the patient, resulting from more frequent surgical procedures 9

Conclusion Compared with GR instrumentation, the hospital charges, physician charges and hospital collections for treating EOS patients were significantly lower with guided growth constructs 10

References 1.Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis: a study of mortality, causes of death, and symptoms. Spine 1992;17: Lloyd-Roberts, GC., Pilcher MF., Structural Idiopathic Scoliosis in Infancy: A Study of the Natural History of 100 Patients. J Bone Joint Surg Br Aug;47: McCarthy RE, Luhmann S, Lenke LG. The Shilla growth guidance technique for early onset spinal deformities at two year follow-up: a preliminary report.Spine.2010[in press]. 4.Tolo VT, Skaggs DL. Master Techniques in Pediatric Orthopaedic Surgery.2008.Philadelphia:Lippincott Williams & Wilkins. 5.Andras, LM., Joiner, EJ, McCarthy, RE, Luhmann, SJ, Sponseller, PD; Emans, JB, Barrett, KK, Skaggs, DL,Growing Spine Study Group. Growing Rods vs. Shilla Growth Guidance: Better Cobb Angle Correction and T1-S1 Length Increase but More Surgeries. Spine Deformity, In press. 11