Medical Student Washington University School of Medicine Corpus Christi, Texas, United States
Introduction: Anterior lumbar interbody fusions (ALIF) have displayed an upward trend for the management of lumbar spinal pathology. This has led to ALIF often being among the highest Medicare reimbursement expenditures therefore it becomes imperative to evaluate ALIF approaches for value-based care. The aim of this study is to describe the operational costs between ALIFs performed as 1-stage versus 2-stage procedures.
Methods: This was a retrospective cohort study of patients who underwent 1-level or 2-level ALIF at Barnes Jewish Hospital from January 2021 to January 2022. Medical billing costs incurred during their individual operating room (OR) and hospital courses (HC) were evaluated. All Hospital Costs (HC) incurred for 18 functional areas were obtained from hospital billing. We compared ancillary costs (AC) and operating costs (OC) between 1-stage and 2-stage procedures for 1- or 2-level ALIF using the Wilcoxon rank sum test and independent U tests.
Results: A total of 16 1-stage or 2-level ALIF surgeries were identified. 7 cases were 1-Stage and 9 were 2-Stage surgeries. The mean OR time of 1-stage surgeries was 403 min (CI 365.59-440.69) and for 2-stage procedures was 530 min (CI 424.85-636.65). The mean LOS of 1-stage surgeries was 2.86 days (CI 1.61-4.1) and for 2-stage procedures was 4.13 days (CI 2.75-5.5). Neither group developed complications during the hospital course. In terms of total operational cost (including OR, AC, and hospital stay costs), the median cost was 50,203.14 USD (SD 8012.21) for 1-stage surgeries and 60,849.22 USD (SD 11744.04) for 2-stage procedures. The differences in OR time, LOS and total operational cost were not statistically significant.
Conclusion : Based on distributions of total operational cost, 1-stage procedures seem to be more efficient in terms of resource utilization for equitable patient outcomes compared to 2-stage procedures. Validation with a larger cohort will help to determine the most cost-effective ALIF approach.
