The Economic Impact of Personalized Diabetes and Smoking Factors for Fusion Patients with Pseudarthrosis

Abstract

Spinal fusion surgery, a prevalent intervention for severe spinal conditions, often leads to significant clinical and economic challenges due to pseudarthrosis or nonunion of bones. Pseudarthrosis occurs in an average of over 30% of cases, causing persistent spinal instability and necessitating costly reoperations, with expenses reaching up to $60,000-100,000. This complication is exacerbated by patient-specific factors, notably smoking and non–insulin-dependent diabetes mellitus (NIDDM). Smoking impairs bone healing by reducing bone mineral density, osteoblastic activity, and local blood flow by 2.7 times a regular patient, while diabetes complicates surgical and healing processes with poor collagen, increasing the risk of nonunion. Advances in surgical materials and techniques, such as titanium alloy porous metal cages and recombinant human bone morphogenetic protein-2 (rhBMP-2), have aimed to improve outcomes, but success rates remain variable. Mitigating these risks involves comprehensive preoperative assessments and tailored interventions. Smoking cessation programs, nicotine replacement therapy (NRT), and strict diabetes management can significantly reduce pseudarthrosis rates. Future research should focus on the long-term efficacy and cost-effectiveness of such interventions and explore emerging technologies like robotic-assisted fusion surgery and advanced biomaterials. Policy-makers should allocate resources to preventive measures and ensure insurance coverage for advanced therapies to enhance patient outcomes and reduce financial burdens. Although these interventions incur varying costs, addressing both surgical and patient-dependent factors can minimize the incidence of pseudarthrosis, improving patient quality of life and potentially saving up to hundreds of millions in economic sustainability within the healthcare system.