Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period
Open Access
- 1 August 2012
- journal article
- research article
- Published by Taylor & Francis Ltd in Risk Management and Healthcare Policy
- Vol. 5, 65-74
- https://doi.org/10.2147/rmhp.s30974
Abstract
Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period John C Lucio,1 R Brent VanConia,1 Kevin J DeLuzio,2 Jeffrey A Lehmen,3 Jody A Rodgers,3 WB Rodgers31St Mary's Health Center, Jefferson City, MO, USA; 2Queen's University, Kingston, Ontario, Canada; 3Spine Midwest, Inc, Jefferson City, MO, USABackground: There is great debate about the costs and benefits of technology-driven medical interventions such as instrumented lumbar fusion. With most analyses using charge data, the actual costs incurred by medical institutions performing these procedures are not well understood. The object of the current study was to examine the differences in hospital operating costs between open and minimally invasive spine surgery (MIS) during the perioperative period.Methods: Data were collected in the form of a prospective registry from a community hospital after specific Institutional Review Board approval was obtained. The analysis included consecutive adult patients being surgically treated for degenerative conditions of the lumbar spine, with either an MIS or open approach for two-level instrumented lumbar fusion. Patient outcomes and costs were collected for the perioperative period. Hospital operating costs were grouped by hospitalization/operative procedure, transfusions, reoperations, and residual events (health care interactions).Results: One hundred and one open posterior lumbar interbody fusion (Open group) and 109 MIS patients were treated primarily for stenosis coupled with instability (39.6% and 59.6%, respectively). Mean total hospital costs were $27,055.53 for the Open group and $24,320.16 for the MIS group. This represents a statistically significant cost savings of $2,825.37 (10.4% [95% confidence interval: $522.51–$5,128.23]) when utilizing MIS over traditional Open techniques. Additionally, residual events, complications, and blood transfusions were significantly more frequent in the Open group, compared to the MIS group.Conclusions/level of evidence: Utilizing minimally invasive techniques for instrumented spinal fusion results in decreased hospital operating costs compared to similar open procedures in the early perioperative period. Additionally, patient benefits of minimally invasive techniques include significantly less blood loss, shorter hospital stays, lower complication rate, and a lower number of residual events. Long-term outcome comparisons are needed to evaluate the efficacy of the two treatments. Level of evidence: IIIClinical relevance: This work represents a true cost-of-operating comparison between open and MIS approaches for lumbar spine fusion, which has relevance to surgeons, hospitals and payers in medical decision-making.Keywords: lumbar, degenerative, complications, MIS, residual eventsKeywords
This publication has 37 references indexed in Scilit:
- Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody FusionSpine, 2011
- Lumbar Fusion in OctogenariansSpine, 2010
- Surgeon Perceptions and Reported Complications in Spine SurgerySpine, 2010
- Methods for the Systematic Reviews on Patient Safety During Spine SurgerySpine, 2010
- National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired SpondylolisthesisSpine, 2009
- Surgical Treatment of Spinal Stenosis with and without Degenerative Spondylolisthesis: Cost-Effectiveness after 2 YearsAnnals of Internal Medicine, 2008
- Cost–utility analysis of routine neurosurgical spinal surgeryJournal of Neurosurgery: Spine, 2006
- Association of Postoperative Complications with Hospital Costs and Length of Stay in a Tertiary Care CenterJournal of General Internal Medicine, 2006
- Cost-Effectiveness of Fusion With and Without Instrumentation for Patients With Degenerative Spondylolisthesis and Spinal StenosisSpine, 2000
- Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population.1993