Spine Surgeon NYU School of Medicine New Canaan, CT, US
Introduction: Compared to repositioning patients for pedicle screw placement after lateral interbody fusion, single-position spine surgery may reduce operative times and operative costs. This study aims to assess surgical outcomes and cost of single position thoracolumbar spine surgery.
Methods: Retrospective analysis of a single-center thoracolumbar spine surgery database. Patients ≥18 years with baseline(BL) and perioperative(Peri-Op) data were included. Patients were separated into single-position(SP) and flipped(F) groups. Total Costs(TC) were calculated from average Medicare DRG reimbursement. Univariate and multivariate analyses assessed differences in baseline demographics, surgical details, and perioperative outcomes between groups.
Results: 200 patients met inclusion(143 SP; 97 F). Demographically, SP patients were older(64.4 vs. 56.4 years,p < .001) with lower BMIs(29.1 vs. 31.5 kg/m2,p=.002). While groups had similar baseline PI-LL, PT and rates of interbody fusion, F patients had more levels fused(3.9 vs. 2.2,p < .001). Yet, multivariable analysis found SP patients had shorter operative times(244 vs. 425 min,p < .001), lower EBL(315.4 vs 562.8 mL,p < .001), and shorter LOS(3.1 vs. 4.8 days,p=.003). Further, SP patients had lower odds of being discharged to rehab(OR: 0.0264, 95% CI: .098 -.881) and lower perioperative cost(SP: $34,875 vs. F: $40,465, p=.019). Compared to the national mean length of stay average for respective DRG, 50% of F patients exceeded the average vs. 21.6% of SP patients, p < .001.
Conclusion : Despite accounting for differences in demographics and surgical details, single position patients had shorter operative times, reduced blood loss, shorter length of stay and were discharged to rehab at significantly lower rates. Additionally, mean cost by DRG was significantly lower for SP patients. While further studies are needed to assess long term outcomes, single position thoracolumbar spine surgery was not associated with increased perioperative complications and could potentially reduce costs associated with operative time and rehabilitation services.
