Economic Process Behind Surgical Innovation

Objective: To analyze trends in open and minimally invasive (MIS) sacroiliac joint fusion (SIJF) that coincide with changes in compensation models and Current Procedural Terminology (CPT) codes. Design: Database analysis Setting: American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Database Patients/Participants: Underwent SIJF, based on CPT codes, from 2007-2018 Intervention: Open and MIS SIJF Main Outcome Measurements: Proportion of open versus MISJ SIJF, proportion of inpatient vs outpatient SIJF, relative value units Results: There were 744 total SIJFs performed. Open SIJFs totaled 683, while 65 MIS SIJFs were performed. The number of SIJFs increased yearly, apart from two years, with a similar trend noted when controlling for the number of NSQIP entries per year. From 2014-2018, MIS SIJF made up a significantly larger proportion of total SIJFs (p<0.0001) and the proportion of outpatient SIJFs increased over the entire study period (p=0.0002). Conclusions: SIJF is being increasingly utilized, coinciding with regulatory approval and the American Medical Association’s formal recognition of MIS SIJF. Related changes to coding and compensation serve as a model for the economic processes behind surgical innovation, highlighting the importance of surgeon advocacy along the way. Level of Evidence: III; Retrospective Cohort Study Keywords: Sacroiliac joint; arthrodesis; fusion; minimally invasive; NSQIP, economics, compensation, policy