Quraishi Danyal A, Sarikonda Advith, Self D Mitchell, Isch Emily L, Glener Steven, Momin Arbaz, Sami Ashmal, Clark Nicholas, Heller Joshua, Prasad Srinivas K, Sharan Ashwini, Jallo Jack, Harrop James, Vaccaro Alexander R, Sivaganesan Ahilan
Drexel University College of Medicine, 60 N 36th St, Philadelphia, PA 19104, United States.
Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, 909 Walnut St, Floor 2, Philadelphia, PA 19104, United States.
N Am Spine Soc J. 2025 Jan 17;21:100583. doi: 10.1016/j.xnsj.2025.100583. eCollection 2025 Mar.
The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence of Body Mass Index (BMI) on intraoperative costs and operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach.
A retrospective analysis was conducted on 279 patients who underwent TLIF between 2019 and 2022. Patients were categorized into 5 BMI cohorts: healthy weight (BMI 18.5-24.99), overweight (BMI 25.0-29.99), Class I obese (BMI 30.0-34.99), Class II obese (BMI 35.0-39.99), and Class III obese (BMI >40). Intraoperative costs were calculated using TDABC methodology, with costs segmented into supply and personnel expenses. Operative times were measured in 3 phases: surgery time (incision to closure), OR time (patient entering to leaving), and turnover time. Multivariable regression models assessed the relationship between BMI and various intraoperative time and cost metrics, adjusting for potential confounders.
BMI was significantly associated with increased operative times and personnel costs. Each unit increase in BMI corresponded to an additional 1.90 minutes in the operating room (p = .01) and a $25.72 increase in personnel costs (p = .008). However, no significant association was found between BMI and total or supply costs. Regression analyses indicated that obese patients did not significantly differ from healthy weight patients in terms of total intraoperative costs.
Higher BMI is associated with increased operative times and personnel costs in TLIF procedures, though it does not significantly impact total intraoperative costs when controlling for confounders. These findings suggest that BMI may not need to be a significant deterrent in patient selection for TLIF under bundled payment models.
肥胖患病率的不断上升引发了人们对其对外科手术结果和医疗成本影响的担忧。本研究采用基于时间驱动作业成本法（TDABC）评估体重指数（BMI）对开放式经椎间孔腰椎椎间融合术（TLIF）术中成本和手术时间的影响。
对2019年至2022年间接受TLIF手术的279例患者进行回顾性分析。患者被分为5个BMI队列：正常体重（BMI 18.5 - 24.99）、超重（BMI 25.0 - 29.99）、I类肥胖（BMI 30.0 - 34.99）、II类肥胖（BMI 35.0 - 39.99）和III类肥胖（BMI >40）。术中成本采用TDABC方法计算，成本分为供应成本和人员费用。手术时间分为3个阶段进行测量：手术时间（切开至缝合）、手术室时间（患者进入至离开）和周转时间。多变量回归模型评估BMI与各种术中时间和成本指标之间的关系，并对潜在混杂因素进行调整。
BMI与手术时间延长和人员成本增加显著相关。BMI每增加一个单位，手术室时间增加1.90分钟（p = 0.01），人员成本增加25.72美元（p = 0.008）。然而，未发现BMI与总成本或供应成本之间存在显著关联。回归分析表明，肥胖患者与正常体重患者在术中总成本方面无显著差异。
在TLIF手术中，较高的BMI与手术时间延长和人员成本增加相关，但在控制混杂因素时，它对术中总成本没有显著影响。这些发现表明，在捆绑支付模式下，BMI可能不一定是TLIF患者选择的重大阻碍因素。
