In the first 5 years of Treatment, the Charges for Guided Growth Constructs are 30% less than

Growing Rods

Lindsay M. Andras MD1, Liam Harris BS1, Scott Yang MD1, Alexander Broom BA1, Howard Park MD2, McKenna Archer MS1,

David L. Skaggs MD MMM1

1.Children’s Orthopaedic Center, Children's Hospital Los Angeles, 2.Orthopaedics, University of California Los Angeles

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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)

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a. Grants/Research Support

b. Consultantc. Stock/Shareholderd. Speakers’ Bureaue. 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

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ObjectiveTo investigate the economics of growing rod versus guided growth constructs for the treatment of early

onset scoliosis

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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

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Results18 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

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Mean Age of Index

Instrumentation

Mean Major Preoperative

Curve

Mean Length of Follow up

Growing Rods 4.8 yrs 83.6° 4.9 yrs

Guided Growth Construct

5.9 yrs 76.5° 4.7 yrs

P-Value 0.28 0.40 0.80

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.

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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 <0.0001 0.0004 0.041 0.093

ResultsMean charges and collections per patient:

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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 constructs5

• However, this has to be weighed against the cost both to the healthcare system and to the patient, resulting from more frequent surgical procedures

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ConclusionCompared with GR instrumentation, the hospital charges, physician charges and

hospital collections for treating EOS patients were significantly lower with guided

growth constructs

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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;17:1091-6.

2. Lloyd-Roberts, GC., Pilcher MF., Structural Idiopathic Scoliosis in Infancy: A Study of the Natural History of 100 Patients. J Bone Joint Surg Br. 1965 Aug;47:520-3

3. 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, 2015. In press.

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