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C5 Palsy Following Posterior Cervical Decompression and Fusion: Cost and Quality of Life Implications.
MedLine Citation:
PMID:  24704502     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND CONTEXT: C5 palsy is a debilitating postoperative complication of cervical decompression surgery. While the prognosis is typically good, patients may be unable to perform basic activities of daily living, resulting in a decreased quality of life. No studies have investigated the quality of life and financial implications.
PURPOSE: To determine the impact on quality of life and costs of C5 palsy following posterior cervical decompression and fusion (PCDF). Study Design/Setting: A 2:1 matched retrospective cohort study was conducted at a single tertiary-care institution between 2007 and 2012.
PATIENT SAMPLE: Individuals that had undergone PCDF.
OUTCOME MEASURES: Self-reported: Euroqol's 5-Dimensions quality of life survey Physiologic: Postoperative change in deltoid and biceps strength via manual muscle testing Functional: Cost of interventions and missed work days postoperatively METHODS: Individuals with postoperative C5 palsy were matched to controls based upon age, gender, BMI, and diagnosis. Demographic, operative, postoperative, quality of life, and cost data were collected for both the C5 palsy and control groups, with 1-year follow-up. No funding sources or conflicts of interest were present.
RESULTS: We reviewed 245 patients that underwent PCDF, and identified 17 (6.9%) with C5 palsy. These were matched to 34 controls. No significant differences in demographic or operative characteristics were observed between groups. The C5 palsy group had a significantly reduced capacity for self-care in the immediate postoperative period (2.0±0.71 vs. 1.2±0.4, p<0.001) and long-term (1.6±0.6 vs. 1.2±0.4, p=0.004), and a significantly reduced capacity for completion of usual activities (2.4±0.7 vs. 1.9±0.6, p=0.014) compared to controls. Furthermore, the C5 group had a significantly greater cost of physical/occupational therapy, an increase of $2078 ($4386±2801 vs. $2307±1907, p=0.013). There were no significant differences between groups in the cost of hospital stay, surgery, or other direct or indirect costs. Overall, there was a significantly greater cost ($1918) for the C5 palsy group compared to the control group ($7584±3992 vs. $5666±2359, respectively; p=0.038).
CONCLUSIONS: This study represents the first quantification of the impact of C5 palsy upon patients' quality of life and the associated costs for care. We found that C5 palsy adds a significant burden upon patients' quality of life, and presents a financial burden to the healthcare system.
Authors:
Jacob A Miller; Daniel Lubelski; Matthew D Alvin; Edward C Benzel; Thomas E Mroz
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-2
Journal Detail:
Title:  The spine journal : official journal of the North American Spine Society     Volume:  -     ISSN:  1878-1632     ISO Abbreviation:  Spine J     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101130732     Medline TA:  Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 Elsevier Inc. All rights reserved.
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