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mended dosing of varenicline . Serum concentrations were then validated using ELISA and liquid chromatography / mass spectrometry testing . The subcutaneous osmotic pumps were exchanged at four weeks to ensure no drop off in the concentration of drug delivery based on our validation data .”
“ Pumps were implanted two weeks prior to surgery as pre-treatment to mimic the real-life scenario of current smokers undergoing surgery , obtaining the desired steady state concentrations in the serum prior to fusion surgery .”
“ Vaping has resulted in a nicotine resurgence with the advent of electronic cigarettes . More often we will be seeing chronic nicotine users in our clinic again .”
“ Surgeons should be apprehensive about performing spinal fusion in nicotine users given the well-documented increased rates of pseudarthrosis and instrumentation failure , alongside worse long-term clinical outcomes . However , our findings have the potential to significantly impact clinical practice guidelines and the use of pharmacotherapy for active nicotine users undergoing fusion surgery .” — EH
How Price Sensitive Are Spine Patients ?
When patients present for spine surgery , they have typically endured weeks if not months of serious pain , tingling and / or numbness . The decision to have surgery is not entered into lightly .
What role , large or small , does the cost of surgery play in their decision to have surgery ?
Researchers from Brown University have completed the first large study which attempts to tease out answers to that interesting question . For the study , Brown ’ s research team asked patients how much they might be willing to pay for various procedures at various price points .
Their work , “ How much are patients willing to pay for spine surgery ? An evaluation of attitudes toward outof-pocket expenses and cost-reducing measures ,” appears in the December 2023 edition of The Spine Journal .
The survey , which generated 979 responses , asked patients about the costs of anterior cervical discectomy and fusion ( ACDF ), degenerative lumbar spinal fusions ( LF ), and adult spine deformity ( ASD ) surgery .
Co-author Alan Daniels , M . D ., associate professor of orthopedics and spine surgery at Brown , told OTW , “ This survey was inspired by an excellent paper by Wahl EP et al that appeared in The Journal of Bone and Joint Surgery : ‘ Patient Perspectives on the Cost of Hand Surgery ’. We were curious how spine surgery patients would match up with patient perspectives regarding the cost of hand surgery . We chose three very different spinal procedures to see how patient perspectives differ based on surgical invasiveness and risk .”
The average age of respondents was 36.2 years , with 44 % of participants reporting a household income of $ 50,000 to 100,000 . A total of 63 % had Medicare and 13 % had Medicaid ; 40 % stated they had high levels of financial stress .
Patients were asked , if they had to pay $ 3,000 , would they still be willing to undergo a spine surgery ? The survey found that 30.1 % of participants were willing to undergo an ACDF , 30.3 % were willing to undergo a degenerative LF , and 29.6 % were willing to undergo ASD .
Interestingly , the researchers found that for ACDF , a $ 100 increase in price resulted in a 2.1 % decrease in willingness to pay ; for degenerative LF surgery it was a 1.8 % decrease , while for ASD surgery it was 2 %.
Cost Savings Data
When patients were asked which measures they were least comfortable with for ACDF :
• 60 % stated “ Use of the older generation implants / devices ” ( LF : 51 %, ASD : 60 %),
• 61 % stated “ Having the surgery performed at a community hospital instead of at a major academic center ” ( LF : 49 %, ASD : 56 %), and
• 55 % stated “ Administration of anesthesia by a nurse anesthetist ” ( LF : 48.01 %, ASD : 55 %).
Conversely , 36 % of ACDF patients were uncomfortable with a “ Video / telephone postoperative visit ” to cut costs ( LF : 51 %, ASD : 39 %).
Patients Want the Latest Technologies , Regardless …
“ Patients were not comfortable forfeiting the latest implants — even though spinal implants from the last
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