Y. Raja Rampersaud MD , Randolph Gray MD , Steven J. Lewis MD , Eric M. Massicotte MD , Michael G. Fehlings MD, PhD
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Oswestry disability index (ODI) and Short Form 36 (SF-36) values were prospectively collected preoperatively and at 1 year postoperatively. Cost-utility analysis was performed by use of in-hospital micro-costing data (operating room, nursing, imaging, laboratories, pharmacy, and allied health cost) and change in health utility index (SF-6D) at 1 year.</p></div><div><h3>Results</h3><p>The groups were comparable in terms of age, sex, preoperative hemoglobin, comorbidities, and body mass index. Groups significantly differed (<em>P</em> < .01) regarding baseline ODI and SF-6D scores, as well as number of 2-level fusions (MIS, 12; open, 20) and number of interbody cages (MIS, 45; open, 14). Blood loss (200 mL vs 798 mL), transfusions (0% vs 17%), and length of stay (LOS) (6.1 days vs 8.4 days) were significantly (<em>P</em> < .01) lower in the MIS group. Complications were also fewer in the MIS group (4 vs 12, <em>P</em> < .02). The mean cost of an open fusion was 1.28 times greater than that of an MIS fusion (<em>P</em> = .001). Both groups had significant improvement in 1-year outcome. The changes in ODI and SF-6D scores were not statistically different between groups. Multivariate regression analysis showed that LOS and number of levels fused were independent predictors of cost. Age and MIS were the only predictors of LOS. Baseline outcomes and MIS were predictors of 1-year outcome.</p></div><div><h3>Conclusion</h3><p>MIS posterior fusion for spondylolisthesis does reduce blood loss, transfusion requirements, and LOS. Both techniques provided substantial clinical improvements at 1 year. The cost utility of the MIS technique was considered comparable to that of the open technique.</p></div><div><h3>Level of Evidence</h3><p>Level III.</p></div>","PeriodicalId":88695,"journal":{"name":"SAS journal","volume":"5 2","pages":"Pages 29-35"},"PeriodicalIF":0.0000,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.esas.2011.02.001","citationCount":"39","resultStr":"{\"title\":\"Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis\",\"authors\":\"Y. Raja Rampersaud MD , Randolph Gray MD , Steven J. Lewis MD , Eric M. Massicotte MD , Michael G. Fehlings MD, PhD\",\"doi\":\"10.1016/j.esas.2011.02.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The utility and cost of minimally invasive surgical (MIS) fusion remain controversial. 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引用次数: 39
摘要
背景微创外科(MIS)融合术的效用和成本仍然存在争议。本研究的主要目的是比较通过MIS技术进行1节段和2节段融合术对I级或II级退行性或峡部滑脱的直接经济影响，与传统的开放式后路减压融合术相比。方法采用78例连续患者的前瞻性资料进行回顾性队列研究，其中37例采用1名外科医生的MIS技术，41例采用3名外科医生的开放式技术。对人口统计学、术中和术后急性期数据进行独立回顾。术前和术后1年前瞻性收集Oswestry残疾指数(ODI)和SF-36值。采用院内微观成本数据(手术室、护理、影像、实验室、药房和联合医疗成本)和1年健康效用指数(SF-6D)变化进行成本-效用分析。结果两组在年龄、性别、术前血红蛋白、合并症和体重指数方面具有可比性。组间差异显著(P <.01)关于基线ODI和SF-6D评分，以及2级融合次数(MIS, 12;开度，20)和体间笼数(MIS, 45;开放、14)。出血量(200 mL vs 798 mL)、输血量(0% vs 17%)和住院时间(LOS)(6.1天vs 8.4天)差异均显著(P <.01)， MIS组低。MIS组并发症也较少(4 vs 12, P <02)。开放融合术的平均成本是MIS融合术的1.28倍(P = 0.001)。两组1年预后均有显著改善。各组ODI和SF-6D评分变化无统计学差异。多元回归分析表明，LOS和融合层次数是成本的独立预测因子。年龄和MIS是LOS的唯一预测因子。基线结果和MIS是1年预后的预测因子。结论腰椎滑脱后路mis融合术可减少失血量、输血需要量和LOS。两种技术在1年后均有显著的临床改善。MIS技术的成本效用被认为与开放技术相当。证据等级:III级。
Cost-utility analysis of posterior minimally invasive fusion compared with conventional open fusion for lumbar spondylolisthesis
Background
The utility and cost of minimally invasive surgical (MIS) fusion remain controversial. The primary objective of this study was to compare the direct economic impact of 1- and 2-level fusion for grade I or II degenerative or isthmic spondylolisthesis via an MIS technique compared with conventional open posterior decompression and fusion.
Methods
A retrospective cohort study was performed by use of prospective data from 78 consecutive patients (37 with MIS technique by 1 surgeon and 41 with open technique by 3 surgeons). Independent review of demographic, intraoperative, and acute postoperative data was performed. Oswestry disability index (ODI) and Short Form 36 (SF-36) values were prospectively collected preoperatively and at 1 year postoperatively. Cost-utility analysis was performed by use of in-hospital micro-costing data (operating room, nursing, imaging, laboratories, pharmacy, and allied health cost) and change in health utility index (SF-6D) at 1 year.
Results
The groups were comparable in terms of age, sex, preoperative hemoglobin, comorbidities, and body mass index. Groups significantly differed (P < .01) regarding baseline ODI and SF-6D scores, as well as number of 2-level fusions (MIS, 12; open, 20) and number of interbody cages (MIS, 45; open, 14). Blood loss (200 mL vs 798 mL), transfusions (0% vs 17%), and length of stay (LOS) (6.1 days vs 8.4 days) were significantly (P < .01) lower in the MIS group. Complications were also fewer in the MIS group (4 vs 12, P < .02). The mean cost of an open fusion was 1.28 times greater than that of an MIS fusion (P = .001). Both groups had significant improvement in 1-year outcome. The changes in ODI and SF-6D scores were not statistically different between groups. Multivariate regression analysis showed that LOS and number of levels fused were independent predictors of cost. Age and MIS were the only predictors of LOS. Baseline outcomes and MIS were predictors of 1-year outcome.
Conclusion
MIS posterior fusion for spondylolisthesis does reduce blood loss, transfusion requirements, and LOS. Both techniques provided substantial clinical improvements at 1 year. The cost utility of the MIS technique was considered comparable to that of the open technique.
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