Higher fusion, decompression costs could relate to instrumentation

Researchers found spine procedures performed by neurosurgeons, not orthopedic surgeons, usually cost less.

BERGEN, Norway — An analysis of lumbar spine fusion data from a large Belgian health database found significantly higher costs associated with posterolateral vs. anterolateral interbody fusions.

Interestingly, researchers found that costs decreased when neurosurgeons performed the procedures.

Robert Gunzburg, MD, of Brussels, and colleagues compared procedural costs by reviewing the surgical procedure codes and the codes for any implants used. Other codes also considered included those that indicated what type of surgeon performed each procedure — either a neurosurgeon or an orthopedic surgeon.

The researchers theorized that the detected higher global surgical cost difference, which was about 1471 euros ($1850) more for posterolateral interbody fusions (PLIF), was possibly due to instrumentation. Hospitalization or intensive care unit costs, for example, were approximately equal between groups, said Gunzburg, who presented the study results at the International Society for Study of the Lumbar Spine 33rd Annual Meeting, here.

Using the database, Gunzburg and colleagues identified 3343 patients treated with lumbar fusion from June 2000 to May 2003. Of these, 1245 patients received anterolateral interbody fusion (ALIF) and 2098 patients received PLIF. Patients in the ALIF group had a mean age of 44 years and PLIF patients had a mean age of 48 years. Women comprised more than half of the patients in each group.

The researchers also identified 4989 patients who underwent concurrent one- to three-level decompressions through extended laminectomies.

Overall, surgeons performed 76.5% of cases without instrumentation and 23.5% with instrumentation.

During the study period, ALIFs cost 5871 euros ($7384) vs. 7342 euros ($9234) for PLIFs (P<.0001), including direct and indirect costs, Gunzburg said.

The researchers used stepwise linear regression analysis to look at all cost factors for the three types of procedures. The laminectomy cost almost doubled when instrumentation was added, he said. It averaged 3756 euros ($4724) when done without instrumentation compared to 7407 euros ($9315) when done using instrumentation (P<.00007).

For more information:
Gunzburg R, Szpalski M, Dubois M, Melot C. Surgeon dependent cost of fusion and decompression: A population study. #46. Presented at the International Society for the Study of the Lumbar Spine 33rd Annual Meeting. June 14-17, 2006. Bergen, Norway.