Variability and contributions to cost associated with anterior versus posterior approaches to lumbar interbody fusion

Lumbar interbody fusions are being performed with increased frequency in the last decade. Anterior and posterior interbody techniques have demonstrated relatively similar success rates. Nonetheless, despite increased attention to cost-effective care delivery, approach-related differences in procedur...

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Bibliographic Details
Published in:Clinical neurology and neurosurgery 2021-07, Vol.206, p.106688-106688, Article 106688
Main Authors: Crawford, Alexander M., Lightsey, Harry M., Xiong, Grace X., Striano, Brendan M., Pisano, Alfred J., Schoenfeld, Andrew J., Simpson, Andrew K.
Format: Article
Language:English
Subjects:
Adult
Aged
ALIF
Clinical outcomes
Cost
Cost control
Demography
Female
Health Care Costs - statistics & numerical data
Health care policy
Hospitals
Humans
Interbody Fusion
Lumbar Vertebrae
Male
Middle Aged
Patients
PLIF
Sensitivity analysis
Spinal Fusion - economics
Spinal Fusion - methods
Surgeons
Surgery
TLIF
Transplants & implants
Value
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Summary:Lumbar interbody fusions are being performed with increased frequency in the last decade. Anterior and posterior interbody techniques have demonstrated relatively similar success rates. Nonetheless, despite increased attention to cost-effective care delivery, approach-related differences in procedural cost and predictors for these differences remain poorly defined. The purpose of this investigation was to characterize the variability in cost for anterior versus posterior-based lumbar interbody fusions and to identify key predictors of procedural cost. We evaluated the records of all patients who underwent a primary anterior (ALIF) or posterior/transforaminal (PLIF/TLIF) lumbar interbody fusion with concomitant posterior fusion from 2016 to 2020 at four hospitals in a major metropolitan area. We reviewed the records of all included patients and abstracted demographics, insurance status, approach, operative time, diagnosis, surgeon, institution, open versus minimally invasive technique, and components of procedural costs. Costs based upon interbody approach were compared via multivariable adjusted analyses using negative binomial regression. We included 139 interbody fusion procedures; 98 were performed via posterior approach (TLIF/PLIF) and 41 using an anterior approach. Anterior techniques were associated with significantly increased costs as compared to posterior procedures (anterior, $16316 [SE 556] vs. posterior, $9415 [SE 345]; p 
ISSN:0303-8467
1872-6968
DOI:10.1016/j.clineuro.2021.106688