245 - Economic Performance of Oblique Lateral Lumbar Interbody Fusion (OLLIF...

#245 Economic Performance of Oblique Lateral Lumbar Interbody Fusion (OLLIF) with a Focus on Hospital Throughput Efficiency

Value and Outcomes in Spine Surgery

Poster Presented by: H. Abbasi

Author(s):

H. Abbasi (1)
C. Murphy (2)

(1) Tristate Brain and Spine Institute, Alexandria, MN, United States
(2) AMW Spine, Minneapolis, MN, United States

Abstract

Summary: Oblique lateral lumbar interbody fusion(OLLIF) is a minimally invasive lumbar surgery. Differences in resource consumption between open spinal surgeries, transformational lumbar interbody fusions (TLIF) and OLLIF, are not documented. We monetize quantifiable differences in resource utilization between the two procedures. A retrospective review of 124 surgeries was performed (OLLIF=69, TLIF=55). Standard conversion factors were used and values reported based on the levels addressed at surgery. One level surgery time (OLLIF 62.9 vs. TLIF 134.9 minutes) and surgical expense (OLLIF$5,253 vs. TLIF$11,264) were reduced in the OLLIF population. Inpatient costs (OLLIF$5,712 vs. TLIF$9,271) and length of stay (LOS) were also reduced (OLLIF 2.6 vs. TLIF 4.2 days). Per case, reduced resource consumption suggests lower total hospital costs. Reduced surgical time and LOS can result in greater patient throughput per operating room and patient bed for OLLIF patients in hospitals that have resourced constrained environments.

Hypothesis: The reduction in the use of these key hospital resources suggests that hospitals that are constrained by OR or hospital bed availability may be able to achieve greater throughput efficiency by increasing the overall percentage of patients receiving the OLLIF surgery.

Methods: All procedures were completed by the same surgeon as single surgeon procedures. Patient surgical indications are listed shown below. To eliminate selection bias, the TLIF control group was selected from patients who underwent surgery before the surgeon started performing OLLIF. All 124 procedures were performed in two Minnesota hospitals. Resource utilization observed in the OLLIF and TLIF surgeries are presented, first matched for the number of levels and then overall. We present perioperative outcome data from 69 OLLIF procedures, compare them to 55 open TLIFs on 125 levels done by the same surgeon, and monetize quantifiable differences in the resource utilization between the two procedures Study design This was a retrospective case series including 69 OLLIF patients and 55 open TLIF controls.

Results: In all groups, OLLIF significantly reduced surgery times, blood loss, and hospital stay compared to TLIF. There was one exception in that there was no significant difference between the two groups in the length of hospital stay in the three level patient groups. In the one level group, mean blood loss was reduced almost 11-fold. In general, blood loss per patient was less in OLLIF when compared with TLIF. Overall, across all surgeries studied, LOS for OLLIF surgeries was 58.5% of that seen with TLIF surgeries (3.1 vs. 5.3 days). The trend of shorter LOS for OLLIF surgeries remained consistent when surgeries were stratified and matched for the same number of levels involved (2.6 vs. 4.2 for one level, 3.2 vs. 5.8 for two levels, 3.2 vs. 4.3 for three levels, and 4.6 vs. 6.7 for four levels). Overall, when LOS was converted to inpatient operating costs of the hospital, the difference in cost of surgical admission was $6,701 for OLLIF vs. $11,583 for TLIF.

Conclusion: The difference in cost of surgery attributable to surgical time was $6,671 for OLLIF vs. $16,029 for TLIF. When LOS was converted to inpatient operating costs of the hospital, the difference in cost of surgical admission was $6,701 for OLLIF vs. $11,583 for TLIF.