Minimally Invasive Spinal Fusion Saves Money, Study Suggests

It pays to take a minimally invasive approach to transforaminal lumbar interbody fusion, according to the investigators of a new study.
In an analysis of procedures performed at Rush University Medical Center in Chicago, researchers found a $5,991 difference in direct and indirect hospital costs between the open and minimally invasive surgery (MIS) approaches. In contrast, the payment received by the hospital was $9,093 higher for the open procedure. The latter finding surprised the team.
“We would have thought that with the benefits of the minimally invasive procedure that have been shown in the literature—combined with the cost savings we showed in our study—that the actual payment would be higher for the minimally invasive route, to give the patients and providers more of an incentive to go with the less costly approach,” said lead investigator Kern Singh, MD, assistant professor of orthopedic surgery at Rush.
Dr. Singh worked with medical student and research coordinator Miguel Pelton, and Frank Phillips, MD, another spine surgeon, both at Rush. They compared the costs associated with open transforaminal lumbar interbody fusion in 33 patients with those for the MIS method in 33 matched patients. All the procedures were performed at Rush between July 1, 2008 and June 30, 2010. The patients who were included did not have revisions nor had more than a one-level transforaminal lumbar interbody fusion.
The estimated blood loss, anesthesia time, surgical time and hospital length of stay were all highly statistically significantly greater with open surgery. This is similar to the findings of previous studies, Dr. Singh noted (J Spinal Disord Tech 2011;24:479-484).
The hospital direct costs including costs for blood, imaging, implants, lab tests, pharmacy, physical therapy, occupational therapy, room and board, and surgical services were $19,224 for MIS and $23,550 for open transforaminal lumbar interbody fusion (P<0.001). The indirect costs for the two procedures, respectively, were $8,097 and $9,762 (P<0.001). Total costs were $27,321 for the MIS approach and $33,312 for the open surgery method, for a difference in favor of MIS of $5,991 (P<0.001). The hospital payments for the MIS group averaged $38,090, whereas the average payment for the open transforaminal lumbar interbody fusion was $47,182.
D. Greg Anderson, MD, professor of orthopedic and neurologic surgery at Thomas Jefferson University and Rothman Institute, Philadelphia, said that although the results are “promising,” two-year cost comparisons are needed to determine whether the benefits of the minimally invasive approach are sustainable over time.
The study was presented at the International Society of the Advancement of Spine Surgery’s 2012 annual meeting, held in Barcelona, Spain (poster 359).
Source:Rosemary Frei, MSc