Crawford Alexander M, Lightsey Harry M, Xiong Grace X, Striano Brendan M, Pisano Alfred J, Schoenfeld Andrew J, Simpson Andrew K
Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Clin Neurol Neurosurg. 2021 Jul;206:106688. doi: 10.1016/j.clineuro.2021.106688. Epub 2021 May 15.
Lumbar interbody fusions are being performed with increased frequency in the last decade. Anterior and posterior interbody techniques have demonstrated relatively similar success rates. Nonetheless, despite increased attention to cost-effective care delivery, approach-related differences in procedural cost and predictors for these differences remain poorly defined. The purpose of this investigation was to characterize the variability in cost for anterior versus posterior-based lumbar interbody fusions and to identify key predictors of procedural cost.
We evaluated the records of all patients who underwent a primary anterior (ALIF) or posterior/transforaminal (PLIF/TLIF) lumbar interbody fusion with concomitant posterior fusion from 2016 to 2020 at four hospitals in a major metropolitan area. We reviewed the records of all included patients and abstracted demographics, insurance status, approach, operative time, diagnosis, surgeon, institution, open versus minimally invasive technique, and components of procedural costs. Costs based upon interbody approach were compared via multivariable adjusted analyses using negative binomial regression.
We included 139 interbody fusion procedures; 98 were performed via posterior approach (TLIF/PLIF) and 41 using an anterior approach. Anterior techniques were associated with significantly increased costs as compared to posterior procedures (anterior, $16316 [SE 556] vs. posterior, $9415 [SE 345]; p < 0.001). This determination remained significant following multivariable adjusted analysis (regression coefficient -0.22, 95% CI -0.34, -0.10, p < 0.001). Multivariable analysis also indicated that surgeon, invasiveness, and procedure time were significant predictors of total cost.
Our findings demonstrate that anterior interbody techniques are, on average, 173% (anterior, $16316 [SE 556] vs. posterior, $9415 [SE 345]; p < 0.001) more expensive than posterior-based procedures. Given the relative equipoise of these different approaches for many clinical applications, these findings should be considered in an ecosystem increasingly attentive to cost effective care delivery. This work has also provided specific procedural variables for surgeons and systems to target when optimizing procedural costs.
在过去十年中，腰椎椎间融合术的实施频率不断增加。前路和后路椎间技术已显示出相对相似的成功率。尽管如此，尽管对具有成本效益的医疗服务给予了更多关注，但手术成本方面与手术方式相关的差异以及这些差异的预测因素仍未得到明确界定。本研究的目的是描述前路与后路腰椎椎间融合术成本的变异性，并确定手术成本的关键预测因素。
我们评估了2016年至2020年在一个大城市地区的四家医院接受初次前路（ALIF）或后路/经椎间孔（PLIF/TLIF）腰椎椎间融合术并同时进行后路融合的所有患者的记录。我们审查了所有纳入患者的记录，并提取了人口统计学、保险状况、手术方式、手术时间、诊断、外科医生、机构、开放与微创技术以及手术成本的组成部分。通过使用负二项回归的多变量调整分析比较基于椎间入路的成本。
我们纳入了139例椎间融合手术；98例通过后路手术（TLIF/PLIF）进行，41例采用前路手术。与后路手术相比，前路技术的成本显著增加（前路，16316美元[标准误556]对后路，9415美元[标准误345]；p < 0.001）。在多变量调整分析后，这一结果仍然显著（回归系数 -0.22，95%可信区间 -0.34，-0.10，p < 0.001）。多变量分析还表明，外科医生、手术侵入性和手术时间是总成本的重要预测因素。
我们的研究结果表明，前路椎间技术平均比后路手术贵173%（前路，16316美元[标准误556]对后路，9415美元[标准误345]；p < 0.001）。鉴于这些不同手术方式在许多临床应用中的相对平衡，在一个越来越关注成本效益医疗服务的生态系统中，应考虑这些发现。这项工作还为外科医生和医疗系统在优化手术成本时提供了具体的手术变量目标。
