Cost-effectiveness of open transforaminal lumbar interbody fusion (OTLIF) versus minimally invasive transforaminal lumbar interbody fusion (MITLIF): a systematic review and meta-analysis

Droeghaag, Ruud; Hermans, Sem M M; Caelers, Inge; Evers, Silvia M. A. A.; Hemert, Wouter L.W. van; Santbrink, Henk van

doi:10.1016/j.spinee.2021.01.018

Cited by 18 publications

(13 citation statements)

References 55 publications

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“…The widespread of surgical interventions has accompanied an increase in health-related costs. In response, cost-effectiveness studies are attracting more attention in the comparison of various surgical techniques [ 27 ]. Furthermore, cost effectiveness cannot be overlooked and plays a major role in current healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

“…Previous economic studies on TLIF surgeries have failed to establish conclusive evidence [ 3 ]. However, in a recent published systematic review comparing open TLIF and MIS-TLIF, the authors concluded that MIS-TLIF might be more cost-effective than open TLIF [ 27 ]. The included articles are not of high-quality evidence, and further studies are warranted.…”

Section: Discussionmentioning

confidence: 99%

“…The included articles are not of high-quality evidence, and further studies are warranted. Moreover, when comparing open TLIF to MIS, healthcare costs were higher in the MIS group by USD 26,526, and societal costs were lower in the MIS group by USD 36,927 [ 27 ]. Indeed, direct and indirect cost analysis is challenging in most reported articles.…”

Section: Discussionmentioning

confidence: 99%

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Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages

et al. 2023

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Background and Objective: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been investigated and shown excellent short- and long-term outcomes. In this paper, we describe a new MIS-TLIF technique and pedicle screw insertion using a marker screw as a guidance method. Moreover, we report perioperative, postoperative, and patient-related outcomes. In addition, this paper outlines major differences in radiation exposure, cost effectiveness and accuracy of Marker Screw Minimally Invasive Transforaminal Interbody Fusion (MS-MIS TLIF) compared to other techniques. We report our technique to share our knowledge and experience with the aim of achieving a better MIS-TLIF that would help both surgeons and patients. Materials and Methods: A prospective case series was conducted between October 2018 and February 2021. Patients undergoing MS-MIS TLIF with marker screws were consecutively included. The surgery did not exceed two levels. The patients’ medical records were reviewed, and the included patients were asked to complete two outcome-questionnaires before surgery and at the six-month visit. The surgical technique is described in this paper. Results: A total of 37 patients were recruited. The mean age was 57.35 ± 12.8 years, and more than half of the patients were females. The most common indications for surgery were degenerative disc disease and spondylolisthesis, with the typical level at L4–5. The operative time was 3.02 ± 0.83 h, while the estimated blood loss was 127.7 ± 71.1 mL. The average time for ambulation and hospitalization was 1 ± 1.1 and 2.84 ± 1.4 days, respectively. The patients described significant improvement in both questionnaires. No screw-related complications or screw revisions were needed up to two years of follow-up. Conclusions: The use of marker screws for pedicle screw placement through a minimally invasive fashion is shown to be a promising technique that can overcome many drawbacks, including cost, operative time, and radiation exposure. Performing MS-MIS TLIF can achieve a 360- degree fusion compared to percutaneous MIS-TLIF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages

et al. 2023

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“…Further Vertuani et al 2018, in a simulation of costs and cost-effectiveness based on the United Kingdom and Italy surgical prices for both MIS and open surgeries, showed that in both countries the MIS techniques were presented with increased cost-effectiveness compared to open procedures [ 34 ]. Finally, Droehaag et al 2021, showed in a recent meta-analysis that MIS-TLIF was more cost-effective than Open TLIF, with all the four included studies lying in the “Less Costly & More Effective” [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive versus open surgery for degenerative lumbar pathologies:a systematic review and meta-analysis

et al. 2022

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Introduction With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several treatment options are available to treat degenerative spinal diseases, such as laminectomies, posterior fusions, and interbody fusions, depending on their locations, correction necessities, and surgeon philosophy. With the advance in technology and surgical knowledge, minimally invasive techniques (MIS) arose as a solution to reduce surgical morbidity, while maintaining the same benefits as the traditionally/open surgeries. Several studies investigated the possible advantages of MIS techniques against the traditional open procedures. However, those articles are usually focused only on one technique or on one pathology. Methods The electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed. Only original articles in English or Portuguese were added to the review, the revision was performed following the PRISMA guideline. Results Fifty-three studies were included in the meta-analysis. Of the studied outcomes the Length of Stay Odds of complications, Blood Loss, and Surgery costs presented significantly favored MIS approaches, while the Last FUP ODI score, and Surgery Time did not differ among the groups. Conclusion Minimally invasive techniques are a remarkably interesting option to traditional open surgeries, as these procedures showed a significant reduction in blood loss, hospitalization time, complications, and surgical costs.

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“…Importantly, the recent evidence also suggests that patients treated with minimally invasive transforaminal lumbar interbody fusion (TLIF), for example, have similar two-year clinical outcomes as patients having open TLIF [ 4 ]. The less invasive characteristics of minimally invasive TLIF are also reflected in an improved health economic profile with studies demonstrating superior cost-effectiveness compared to open fusion procedures [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 2: Assessment of Surgical Safety in Medicare Beneficiaries

Schlesinger¹,

Maggio²,

Lorio³

et al. 2023

JPM

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(1) Background: The clinical benefits and procedural efficiencies of performing minimally invasive fusion procedures, such as transforaminal lumbar interbody fusion (TLIF), in the ambulatory surgery center (ASC) are becoming increasingly well established. Currently, Medicare does not provide reimbursement for its beneficiaries eligible for TLIF in the ASC due to a lack of evidence regarding procedural safety. However, the initiation of the Hospital Without Walls program allowed for traditional hospital procedures to be relocated to other facilities such as ASCs, providing a unique opportunity to evaluate the utility of TLIF in the ASC in Medicare-age patients. (2) Methods: This single-center, retrospective study compared baseline characteristics, intraoperative variables, and 30-day postoperative safety outcomes between 48 Medicare-age patients undergoing TLIF in the ASC and 48 patients having the same procedure as hospital in-patients. All patients had a one-level TLIF using the VariLift®-LX expandable lumbar interbody fusion device. (3) Results: There were similar patient characteristics, procedural efficiency, and occurrence of clinical 30-day safety events between the two study groups. However, there was a marked and statistically significant difference in the median length of stay favoring TLIF patients treated in the ASC (23.9 h vs. 1.6 h, p = 0.001). All ASC-treated patients were discharged on the day of surgery. Postoperative visits to address adverse events were rare in either group. (4) Conclusions: These findings provide evidence that minimally invasive TLIF can be performed safely and efficiently in the ASC in Medicare-age patients. With same-day discharge, fusion procedures performed in the ASC offer a similar safety and more attractive cost–benefit profile for older patients than the same surgery undertaken in the traditional hospital setting. The Centers for Medicare and Medicaid Services should strongly consider extending the appropriate reimbursement codes (CPT ® 22630, 22633) for minimally invasive TLIF and PLIF to the ASC Covered Procedure List so that Medicare-age patients can realize the clinical benefits of surgeries performed in this setting.

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Cost-effectiveness of open transforaminal lumbar interbody fusion (OTLIF) versus minimally invasive transforaminal lumbar interbody fusion (MITLIF): a systematic review and meta-analysis

Cited by 18 publications

References 55 publications

Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages

Marker Screw Utilization for Minimally Invasive Transforaminal Lumbar Interbody Fusion (MS-MIS TLIF): Promises and Advantages

Minimally invasive versus open surgery for degenerative lumbar pathologies:a systematic review and meta-analysis

Comparison of Transforaminal Lumbar Interbody Fusion in the Ambulatory Surgery Center and Traditional Hospital Settings, Part 2: Assessment of Surgical Safety in Medicare Beneficiaries

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