Singh Binoy K, Singh Bineta, Mukherjee Aishik, Dey Biswajit, Kumar Sumit, Ghosh Tamajyoti
Neurosurgery, All India Institute of Medical Sciences, Raipur, Raipur, IND.
Pharmacology, Jodhpur Institute of Engineering and Technology Medical College and Hospital, Jodhpur, IND.
Cureus. 2025 Mar 22;17(3):e80986. doi: 10.7759/cureus.80986. eCollection 2025 Mar.
Background and objective Traumatic spinal cord injury often results in significant disability, requiring timely surgical intervention to reduce long-term consequences. In low- and middle-income countries, the fragmented healthcare system and high out-of-pocket costs limit access to spinal fixation surgeries, especially for those in the lower income groups. This study aimed to identify the major cost drivers of spinal fixation surgeries and explore strategies to reduce them, making them more affordable for patients without compromising outcomes. Methodology This study, conducted at a tertiary care hospital, included 120 patients with traumatic spinal injuries. We analyzed costs related to surgery, including laboratory, radiology, pharmacy, and implant expenses, and compared a prospective group with cost-reducing strategies to a retrospective group. Results A total of 120 patients (60 in each group) participated in the study. The major cost driver identified was the implants, particularly screws and rods, which constituted 59% of the total cost of surgery. In the prospective group, the use of short-segment fixation and less expensive implant materials (e.g., titanium mesh cages and metallic disc spacers) led to a significant reduction in costs compared to the retrospective group. Though the mean cost of the implants was significantly lower in the prospective group, there was no difference in surgical outcomes between the two groups. Post-operative complications and readmission rates were similar in both groups and outcomes in terms of neurological improvement were also comparable. Conclusion Implant costs are the primary driver of expenses in spinal surgeries. Using short-segment fixation and cost-effective implants reduce costs without affecting outcomes, improving access for patients belonging to low- and middle-income categories. Further studies are needed to evaluate the long-term cost-effectiveness of this strategy.
背景与目的 创伤性脊髓损伤常导致严重残疾，需要及时进行手术干预以减少长期后果。在低收入和中等收入国家，医疗保健系统碎片化以及高额的自付费用限制了脊柱固定手术的可及性，尤其是对低收入群体而言。本研究旨在确定脊柱固定手术的主要成本驱动因素，并探索降低这些因素的策略，使患者在不影响手术效果的前提下能够负担得起手术费用。方法 本研究在一家三级护理医院开展，纳入了120例创伤性脊柱损伤患者。我们分析了与手术相关的成本，包括实验室、放射科、药房和植入物费用，并将采用成本降低策略的前瞻性组与回顾性组进行比较。结果 共有120例患者（每组60例）参与了研究。确定的主要成本驱动因素是植入物，特别是螺钉和棒材，其占手术总成本的59%。在前瞻性组中，与回顾性组相比，采用短节段固定和使用成本较低的植入材料（如钛网笼和金属椎间盘间隔器）导致成本显著降低。尽管前瞻性组中植入物的平均成本显著较低，但两组之间的手术效果并无差异。两组的术后并发症和再入院率相似，神经功能改善方面的结果也相当。结论 植入物成本是脊柱手术费用的主要驱动因素。使用短节段固定和具有成本效益的植入物可在不影响手术效果的情况下降低成本，改善低收入和中等收入患者的可及性。需要进一步研究来评估该策略的长期成本效益。
