Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Comparative Effectiveness and Cost-Utility Analysis

• Published in: World neurosurgery Vol. 82; no. 1; pp. 230 - 238
• Main Authors: Parker, Scott L, Mendenhall, Stephen K, Shau, David N, Zuckerman, Scott L, Godil, Saniya S, Cheng, Joseph S, McGirt, Matthew J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2014
• Subjects: Adolescent; Adult; Aged; Blood Loss, Surgical; Comparative effectiveness; Cost-Benefit Analysis; Cost-utility; Costs and Cost Analysis; Female; Fluoroscopy; Hospital Costs; Humans; Length of Stay; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; Male; Middle Aged; Minimally Invasive Surgical Procedures - methods; Narcotics - therapeutic use; Neurosurgery; Pain - drug therapy; Pain - etiology; Perioperative Care; Postoperative Complications - economics; Postoperative Complications - epidemiology; Quality-Adjusted Life Years; Return to Work; Spinal Fusion - methods; Spondylolisthesis; Spondylolisthesis - complications; Spondylolisthesis - economics; Spondylolisthesis - surgery; Transforaminal lumbar interbody fusion; Treatment Outcome; Young Adult; PCS; Postoperative anesthesia care unit; PACU; Transforaminal lumbar interbody fusion; Diagnosis-related group; LP-VAS; BP-VAS; Mental component score; ODI; Visual analog scale–back pain; Short-Form 12; Incremental cost-effectiveness ratio; Oswestry Disability Index; Spondylolisthesis; ICER; SF-12; IQR; Cost-utility; Comparative effectiveness; Minimally invasive surgery; TLIF; Quality-adjusted life year; MIS; Interquartile range; DRG; QALY; Physical Component Score; Visual analog scale–leg pain; MCS
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2013.01.041

Background Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for the surgical treatment of back/leg pain while minimizing tissue injury and accelerating the patient's recovery. Although previous results have shown shorter hospital stays and decreased intraoperative blood loss for MIS versus open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS versus open TLIF. Methods A total of 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource use, missed work, and quality-adjusted life years were assessed. Cost of in-patient care, direct cost (2-year resource use × unit costs based on Medicare national allowable payment amounts), and indirect cost (work-day losses × self-reported gross-of-tax wage rate) were recorded, and the incremental cost-effectiveness ratio was calculated. Results Length of hospitalization and time to return to work were less for MIS versus open TLIF ( P  = 0.006 and P  = 0.03, respectively). MIS versus open TLIF demonstrated similar improvement in patient-reported outcomes assessed. MIS versus open TLIF was associated with a reduction in mean hospital cost of $1758, indirect cost of $8474, and total 2-year societal cost of $9295 ( P  = 0.03) but similar 2-year direct health care cost and quality-adjusted life years gained. Conclusions MIS TLIF resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost-saving advancement from a societal and hospital perspective.