Comparative Analysis of Surgical Site Infection After Minimally Invasive Versus Open Posterior/Transforaminal Lumbar Interbody Fusion: Analysis of Hospital Billing and Discharge Data From 5328 Patients

Object Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. Methods The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters. Results Five thousand one hundred seventy patients undergoing P/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P/TLIF, the incidence of SSI (27 [4.6%] vs 150 [7.0%], p = 0.037) and mean SSI-associated cost per P/TLIF ($756 vs $1140, p = 0.030) were both significantly lower among MI-treated patients. In a multivariate model that accounted for differences in demographics and patient severity, open fusion was associated with a strong trend of increased incidence of SSI as compared with MI fusion (OR 1.469, 95% CI 0.959–2.250). Conclusions In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P/TLIF.

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Comparative Analysis of Open Versus Minimally Invasive Techniques for Posterior or Transforaminal Lumbar Interbody Fusion

Evidence for Neurosurgery ◽

10.1007/978-3-030-16323-5_17 ◽

2019 ◽

pp. 257-276

Author(s):

Lee Hwang ◽

Vikram Chakravarthy ◽

William Kemp ◽

Michael Steinmetz ◽

Edward Benzel

Keyword(s):

Comparative Analysis ◽

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Minimally Invasive Techniques ◽

Open Versus ◽

Invasive Techniques

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COMPARATIVE ANALYSIS OF THE RESULTS OF OPEN AND MINIMALLY INVASIVE TRANSFORAMINAL LUMBAR INTERBODY FUSION

The Journal of scientific articles Health and Education millennium ◽

10.26787/nydha-2226-7425-2018-20-8-83-88 ◽

2018 ◽

Vol 20 (8) ◽

pp. 83-88

Author(s):

I.V. Volkov ◽

◽

D.A. Ptashnikov ◽

V.V. Khlebov ◽

◽

...

Keyword(s):

Comparative Analysis ◽

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion

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Comparative Analysis between Minimally Invasive and Open Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis and Lumbar Spondylolisthesis

Global Spine Journal ◽

10.1055/s-0035-1554415 ◽

2015 ◽

Vol 5 (1_suppl) ◽

pp. s-0035-1554415-s-0035-1554415

Author(s):

Dechun Wang

Keyword(s):

Comparative Analysis ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Lumbar Spinal ◽

Lumbar Spondylolisthesis

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Spinal Subdural Abscess following Transforaminal Lumbar Interbody Fusion

Case Reports in Orthopedics ◽

10.1155/2020/7372821 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Isamu Miura ◽

Motoo Kubota ◽

Oji Momosaki ◽

Kento Takebayashi ◽

Takakazu Kawamata ◽

...

Keyword(s):

Surgical Site Infection ◽

Interbody Fusion ◽

Fluid Collection ◽

Cauda Equina ◽

Transforaminal Lumbar Interbody Fusion ◽

Balloon Kyphoplasty ◽

Lumbar Interbody Fusion ◽

Site Infection ◽

Lumbar Vertebral Fracture ◽

Subdural Abscess

Spinal subdural abscesses are rare lesions. We report the case of surgical site infection complicated with meningitis and rapidly progressive spinal subdural abscess caused by P. aeruginosa following transforaminal lumbar interbody fusion (TLIF). A 72-year-old woman was admitted to our hospital complaining of drop foot syndrome and sciatica caused by stenosis of the L5/6 intervertebral foramen accompanied by L5 lumbar vertebral fracture. Accordingly, TLIF of L5-L6 and balloon kyphoplasty of L5 were performed. On the 3rd postoperative day (POD), she was diagnosed with surgical site infection complicated with bacterial meningitis. Subcutaneous fluid, blood, and cerebrospinal fluid cultures indicated P. aeruginosa. On the 7th POD, a repeat MRI showed a large dorsal fluid collection consistent with a subdural infection and massive cauda equina compression. We performed debridement and instrument removal and found a dural laceration that was not observed during the first operation. An intraoperative insensible dural laceration may cause bacteria intrusion into the subdural space.

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Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion

Journal of Neurosurgery Spine ◽

10.3171/2019.6.spine1965 ◽

2020 ◽

Vol 32 (1) ◽

pp. 31-35

Author(s):

Mladen Djurasovic ◽

Jeffrey L. Gum ◽

Charles H. Crawford ◽

Kirk Owens ◽

Morgan Brown ◽

...

Keyword(s):

Cost Effectiveness ◽

Minimally Invasive ◽

Interbody Fusion ◽

Smoking Status ◽

Transforaminal Lumbar Interbody Fusion ◽

Direct Costs ◽

Lumbar Interbody Fusion ◽

Related Quality ◽

Health Related

OBJECTIVEThe midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF.METHODSFrom a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D.RESULTSOf 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551).CONCLUSIONSCompared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

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