Reduced acute care costs with the ERASR minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion

Michael Y. Wang, Hsuan Kan Chang, Jay Grossman

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Enhancing Recovery After Surgery (ERAS R ) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementationofa“fasttrack”surgeryforlumbarfusionanditseffectonacutecarehospi-talization costs. OBJECTIVE: To determine if a “fast track”surgery methodology results in acute care cost savings. METHODS: Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS R group. RESULTS: Patients had similar medical comorbidities (2.02 vs 2 for ERAS R and comparator groups, respectively; P= .458). Body mass index was similar (26.5 vs 27.0; P= .329). ERASR patients were older (65 vs 59 yr, P= .031). Both groups had excellent clinical results with an improvementof23%and24%,respectively.Intraoperativebloodlosswasless(68±31ccvs 231±73,P<0.001).LengthofstaywasalsolesswithERAS R surgery,atameanof1.23±0.8d vs 3.9 ± 1.1 d (P= 0.009). When comparing ERAS R surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was$19212vs$22656,respectively(P<0.001).Thisreflectedanaverageof$3444insavings, which was a 15.2% reduction. CONCLUSION: ERAS R programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

Original languageEnglish (US)
Pages (from-to)827-834
Number of pages8
JournalClinical neurosurgery
Volume83
Issue number4
DOIs
StatePublished - Jan 1 2018

Fingerprint

Costs and Cost Analysis
Spinal Fusion
Cost Savings
Bupivacaine
Decompression
Comorbidity
Hospitalization
Body Mass Index
Injections

Keywords

  • Anesthesia
  • Cost
  • Economic
  • Enhancing recovery
  • ERAS
  • Exparel
  • Minimally invasive
  • Pedicle screw
  • Percutaneous
  • QALY
  • Spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

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title = "Reduced acute care costs with the ERASR minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion",
abstract = "BACKGROUND: Enhancing Recovery After Surgery (ERAS R ) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementationofa“fasttrack”surgeryforlumbarfusionanditseffectonacutecarehospi-talization costs. OBJECTIVE: To determine if a “fast track”surgery methodology results in acute care cost savings. METHODS: Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS R group. RESULTS: Patients had similar medical comorbidities (2.02 vs 2 for ERAS R and comparator groups, respectively; P= .458). Body mass index was similar (26.5 vs 27.0; P= .329). ERASR patients were older (65 vs 59 yr, P= .031). Both groups had excellent clinical results with an improvementof23{\%}and24{\%},respectively.Intraoperativebloodlosswasless(68±31ccvs 231±73,P<0.001).LengthofstaywasalsolesswithERAS R surgery,atameanof1.23±0.8d vs 3.9 ± 1.1 d (P= 0.009). When comparing ERAS R surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was$19212vs$22656,respectively(P<0.001).Thisreflectedanaverageof$3444insavings, which was a 15.2{\%} reduction. CONCLUSION: ERAS R programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.",
keywords = "Anesthesia, Cost, Economic, Enhancing recovery, ERAS, Exparel, Minimally invasive, Pedicle screw, Percutaneous, QALY, Spine",
author = "Wang, {Michael Y.} and Chang, {Hsuan Kan} and Jay Grossman",
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T1 - Reduced acute care costs with the ERASR minimally invasive transforaminal lumbar interbody fusion compared with conventional minimally invasive transforaminal lumbar interbody fusion

AU - Wang, Michael Y.

AU - Chang, Hsuan Kan

AU - Grossman, Jay

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: Enhancing Recovery After Surgery (ERAS R ) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementationofa“fasttrack”surgeryforlumbarfusionanditseffectonacutecarehospi-talization costs. OBJECTIVE: To determine if a “fast track”surgery methodology results in acute care cost savings. METHODS: Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS R group. RESULTS: Patients had similar medical comorbidities (2.02 vs 2 for ERAS R and comparator groups, respectively; P= .458). Body mass index was similar (26.5 vs 27.0; P= .329). ERASR patients were older (65 vs 59 yr, P= .031). Both groups had excellent clinical results with an improvementof23%and24%,respectively.Intraoperativebloodlosswasless(68±31ccvs 231±73,P<0.001).LengthofstaywasalsolesswithERAS R surgery,atameanof1.23±0.8d vs 3.9 ± 1.1 d (P= 0.009). When comparing ERAS R surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was$19212vs$22656,respectively(P<0.001).Thisreflectedanaverageof$3444insavings, which was a 15.2% reduction. CONCLUSION: ERAS R programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

AB - BACKGROUND: Enhancing Recovery After Surgery (ERAS R ) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementationofa“fasttrack”surgeryforlumbarfusionanditseffectonacutecarehospi-talization costs. OBJECTIVE: To determine if a “fast track”surgery methodology results in acute care cost savings. METHODS: Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS R group. RESULTS: Patients had similar medical comorbidities (2.02 vs 2 for ERAS R and comparator groups, respectively; P= .458). Body mass index was similar (26.5 vs 27.0; P= .329). ERASR patients were older (65 vs 59 yr, P= .031). Both groups had excellent clinical results with an improvementof23%and24%,respectively.Intraoperativebloodlosswasless(68±31ccvs 231±73,P<0.001).LengthofstaywasalsolesswithERAS R surgery,atameanof1.23±0.8d vs 3.9 ± 1.1 d (P= 0.009). When comparing ERAS R surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was$19212vs$22656,respectively(P<0.001).Thisreflectedanaverageof$3444insavings, which was a 15.2% reduction. CONCLUSION: ERAS R programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

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KW - Cost

KW - Economic

KW - Enhancing recovery

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KW - Exparel

KW - Minimally invasive

KW - Pedicle screw

KW - Percutaneous

KW - QALY

KW - Spine

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