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Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion.
J Neurosurg Spine 2019; :1-5JN

Abstract

OBJECTIVE

The midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF.

METHODS

From a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D.

RESULTS

Of 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551).

CONCLUSIONS

Compared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

Authors+Show Affiliations

Departments of1Orthopaedic Surgery and.Departments of1Orthopaedic Surgery and.Departments of1Orthopaedic Surgery and.2Research, Norton Leatherman Spine Center, Louisville, Kentucky.2Research, Norton Leatherman Spine Center, Louisville, Kentucky.Departments of1Orthopaedic Surgery and.Departments of1Orthopaedic Surgery and.2Research, Norton Leatherman Spine Center, Louisville, Kentucky.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31518977

Citation

Djurasovic, Mladen, et al. "Cost-effectiveness of Minimally Invasive Midline Lumbar Interbody Fusion Versus Traditional Open Transforaminal Lumbar Interbody Fusion." Journal of Neurosurgery. Spine, 2019, pp. 1-5.
Djurasovic M, Gum JL, Crawford CH, et al. Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion. J Neurosurg Spine. 2019.
Djurasovic, M., Gum, J. L., Crawford, C. H., Owens, K., Brown, M., Steele, P., ... Carreon, L. Y. (2019). Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion. Journal of Neurosurgery. Spine, pp. 1-5. doi:10.3171/2019.6.SPINE1965.
Djurasovic M, et al. Cost-effectiveness of Minimally Invasive Midline Lumbar Interbody Fusion Versus Traditional Open Transforaminal Lumbar Interbody Fusion. J Neurosurg Spine. 2019 Sep 13;1-5. PubMed PMID: 31518977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion. AU - Djurasovic,Mladen, AU - Gum,Jeffrey L, AU - Crawford,Charles H, AU - Owens,Kirk, AU - Brown,Morgan, AU - Steele,Portia, AU - Glassman,Steven D, AU - Carreon,Leah Y, Y1 - 2019/09/13/ PY - 2019/01/18/received PY - 2019/06/25/accepted PY - 2019/9/14/entrez PY - 2019/9/14/pubmed PY - 2019/9/14/medline KW - ASA = American Society of Anesthesiologists Physical Status Classification System KW - HRQOL = health-related quality of life KW - MIDLIF = midline TLIF KW - ODI = Oswestry Disability Index KW - TLIF = transforaminal lumbar interbody fusion KW - cortical screw KW - cost-effectiveness KW - health-related quality of life KW - lumbar fusion KW - midline transforaminal lumbar interbody fusion SP - 1 EP - 5 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine N2 - OBJECTIVE: The midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF. METHODS: From a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D. RESULTS: Of 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551). CONCLUSIONS: Compared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/31518977/Cost-effectiveness_of_minimally_invasive_midline_lumbar_interbody_fusion_versus_traditional_open_transforaminal_lumbar_interbody_fusion L2 - https://thejns.org/doi/10.3171/2019.6.SPINE1965 DB - PRIME DP - Unbound Medicine ER -