Neurophysiological monitoring during cervical spine surgeries: Longitudinal costs and outcomes.

Paper: Neurophysiological monitoring during cervical spine surgeries: Longitudinal costs and outcomes. John P. Ney a,, Daniel P. Kessler b,c J.P. Ney, D.P. Kessler / Clinical Neurophysiology 129 (2018) 2245–2251

Dr. John Ney from Boston University teamed up with a world-renowned Stanford economist, Daniel Kessler, on an important new article on the utility and value of intraoperative neuromonitoring (IONM) in anterior cervical discectomy and fusion (ACDF).

The outcome measures used to evaluate IONM have presumed that immediate onset dysfunction is the best measure of utility and value; however, the true value of IONM to patients and the overall justification of IONM is multifactorial and long-term.

Ney & Kessler (2018) examined longitudinal costs and outcomes associated with single level ACDF, comparing monitored and unmonitored groups. When regression analyses were performed to isolate the effects of IONM on individual variables, the use of IONM was found to decrease costs and improve outcomes.

In terms of costs, while IONM was associated with additional spending during the surgical admission period, the IONM group had significantly less spending (for a net decrease in spending) in the year after admission. The use of IONM during ACDF also resulted in a significant decrease in length of stay.

In terms of outcomes, patients receiving IONM during ACDF had neurological complication rates nearly 80% lower than those without IONM. Furthermore, readmission rates for patients receiving IONM were significantly lower at 30 days and over the year. IONM also was associated with a significant decline in the rate of opioid prescription at one year.

In conclusion, when all relevant variables are controlled for using appropriate statistical analyses, the use of IONM during ACDF decreased neurological complications and decreased overall healthcare costs.


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