Immediate Reconstruction of Oncologic Spinal Wounds Is Cost-Effective Compared with Conventional Primary Wound Closure

Background: Several studies have demonstrated a reduced wound complication rate when immediate soft-tissue reconstruction is performed after complex spine instrumentations in high-risk patients; however, the cost-effectiveness of this technique is not known. The authors hypothesized that immediate soft-tissue reconstruction of oncologic spine wounds would be a cost-effective strategy compared with the standard of care (i.e., oncologic spine surgery with conventional primary wound closure). Methods: The authors used a decision tree model to evaluate the cost-utility, from the perspective of a hospital/insurer, of immediate reconstruction relative to the standard of care after oncologic spine surgery. A systematic review of the literature on oncologic spine surgery and immediate and delayed spinal wound reconstruction was performed to estimate health state probabilities. Overall expected cost and quality-adjusted life-years were assessed using a Monte Carlo simulation and sensitivity analyses. Results: Immediate soft-tissue reconstruction after oncologic spine surgery had an expected cost of $81,458.90 and an expected average of 24.19 quality-adjusted life-years, whereas primary wound closure (no reconstruction) had an expected cost of $83,434.34 and an expected average of 24.17 quality-adjusted life-years, making immediate reconstruction the dominant, most cost-effective strategy. Monte Carlo sensitivity analysis demonstrated that immediate reconstruction was the preferred and most cost-effective option in the majority of simulations. Even when the willingness-to-pay threshold varied from $0 to $100,000 per quality-adjusted life-year, immediate reconstruction remained the dominant strategy across all iterations. Conclusion: This cost-utility analysis suggests that immediate soft-tissue reconstruction after oncologic spine surgery is more cost-effective than primary closure alone.