Acute hospital costs after minimally invasive versus open lumbar interbody fusion: Data from a US national database with 6106 patients

Michael Y. Wang, Jason Lerner, James Lesko, Matthew J. McGirt

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

STUDY DESIGN: Retrospective multi-institutional database review. OBJECTIVE: To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. SUMMARY OF BACKGROUND DATA: Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. METHODS: This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. RESULTS: A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. CONCLUSIONS: This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.

Original languageEnglish
Pages (from-to)324-328
Number of pages5
JournalJournal of Spinal Disorders and Techniques
Volume25
Issue number6
DOIs
StatePublished - Aug 1 2012
Externally publishedYes

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Hospital Costs
Spine
Databases
Minimally Invasive Surgical Procedures
Length of Stay
Hospitalization
Costs and Cost Analysis
Cost Savings
Economic Inflation
International Classification of Diseases
Ambulatory Surgical Procedures
Geography
Hospital Records
Operating Rooms
Comorbidity
Inpatients
Pain

Keywords

  • comparative effectiveness
  • complications
  • cost
  • economic analysis
  • healthcare utilization
  • length of stay
  • minimally invasive
  • socioeconomic
  • spine surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Acute hospital costs after minimally invasive versus open lumbar interbody fusion : Data from a US national database with 6106 patients. / Wang, Michael Y.; Lerner, Jason; Lesko, James; McGirt, Matthew J.

In: Journal of Spinal Disorders and Techniques, Vol. 25, No. 6, 01.08.2012, p. 324-328.

Research output: Contribution to journalArticle

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abstract = "STUDY DESIGN: Retrospective multi-institutional database review. OBJECTIVE: To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. SUMMARY OF BACKGROUND DATA: Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. METHODS: This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. RESULTS: A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. CONCLUSIONS: This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.",
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T1 - Acute hospital costs after minimally invasive versus open lumbar interbody fusion

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AU - Wang, Michael Y.

AU - Lerner, Jason

AU - Lesko, James

AU - McGirt, Matthew J.

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N2 - STUDY DESIGN: Retrospective multi-institutional database review. OBJECTIVE: To determine if minimally invasive interbody fusion is associated with cost savings when compared with open surgery. SUMMARY OF BACKGROUND DATA: Minimally invasive spine (MIS) surgeries are increasingly recognized as equivalent to open procedures. Although these techniques have been advocated for reducing pain, disability, and length of hospitalization, to date there has been little data demonstrating these benefits. METHODS: This study analyzed inpatient hospital records from the Premier Perspective database (2002 to 2009), including patients who underwent a posterior lumbar fusion with interbody cage placement by ICD-9 code, and had implant charge codes that allowed determination if MIS pedicle screws were utilized. Exclusion criteria included a refusion surgery, deformity, >2 levels, and anterior fusion. Total costs were adjusted for covariates (age, sex, race, hospital geography and setting, payor, and comorbidities) using an analysis of covariance model. RESULTS: A total of 6106 patients were identified (1667 MIS and 4439 open). Length of stay (LOS) for 1-level MIS surgery averaged of 3.35 days versus 3.6 days for open surgery (P≤0.006). For 2-level MIS surgery LOS averaged of 3.4 days versus 4.03 days for open surgery (P≤0.001). Total inflation-adjusted acute hospitalization cost averaged $29,187 for 1-level MIS procedures versus $29,947 for open surgery, a nonsignificant difference (P=0.55). Total inflation-adjusted acute hospitalization cost averaged $2106 lower for 2-level MIS surgery (total costs of $33,879 for MIS vs. $35,984 for open surgery, P=0.0023). Cost savings were attributable primarily to lower room and board ($857), operating room ($359), pharmacy ($304), and laboratory ($166) costs in the MIS group. High variances in the 2-level open surgery with prolonged hospital stay also accounted for overall cost differences. CONCLUSIONS: This data from a large nationwide sample of hospitalizations demonstrates that MIS lumbar interbody fusion results in a statistically significant reduction in hospital LOS and a reduction in total hospital costs with 2-level surgery after adjusting for significant covariates. The majority of cost savings from MIS surgery were due to more rapid mobilization and discharge, as well as a reduction in outliers with extended hospitalizations.

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KW - complications

KW - cost

KW - economic analysis

KW - healthcare utilization

KW - length of stay

KW - minimally invasive

KW - socioeconomic

KW - spine surgery

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