title: Comparative charge analysis of one- and two-level lumbar total disc arthroplasty versus circumferential lumbar fusion.
abstract: METHODS
  This is a retrospective, independent study comparing 2 groups of patients treated surgically for discogenic low back pain associated with degenerative disc disease (DDD) in the lumbosacral spine.
  
  
  OBJECTIVE
  To compare the surgical and hospitalization charges associated with 1- and 2-level lumbar total disc replacement and circumferential lumbar fusion.
  
  
  BACKGROUND
  Reported series of lumbar total disc replacement have been favorable. However, economic aspects of lumbar total disc replacement (TDR) have not been published or studied. This information is important considering the recent widespread utilization of new technologies. Recent studies have demonstrated comparable short-term clinical results between TDR and lumbar fusion recipients. Relative charges may be another important indicator of the most appropriate procedure. We report a hospital charge-analysis comparing ProDisc lumbar disc replacement with circumferential fusion for discogenic low back pain.
  
  
  METHODS
  In a cohort of 53 prospectively selected patients with severe, disabling back pain and lumbar disc degeneration, 36 received Synthes ProDisc TDR and 17 underwent circumferential fusion for 1- and 2-level degenerative disc disease between L3 and S1. Randomization was performed using a 2-to-1 ratio of ProDisc recipients to control spinal fusion recipients. Charge comparisons, including operating room charges, inpatient hospital charges, and implant charges, were made from hospital records using inflation-corrected 2006 U.S. dollars. Operating room times, estimated blood loss, and length of stay were obtained from hospital records as well. Surgeon and anesthesiologist fees were, for the purposes of comparison, based on Medicare reimbursement rates. Statistical analysis was performed using a 2-tailed Student t test.
  
  
  RESULTS
  For patients with 1-level disease, significant differences were noted between the TDR and fusion control group. The mean total charge for the TDR group was $35,592 versus $46,280 for the fusion group (P = 0.0018). Operating room charges were $12,000 and $18,950, respectively, for the TDR and fusion groups (P < 0.05). Implant charges averaged $13,990 for the fusion group, which is slightly higher than the $13,800 for the ProDisc (P = 0.9). Estimated blood loss averaged 794 mL in the fusion group versus 412 mL in the TDR group (P = 0.0058). Mean OR minutes averaged 344 minutes for the fusion group and 185 minutes for the TDR (P < 0.05) Mean length of stay was 4.78 days for fusion versus 4.32 days for TDR (P = 0.394). For patients with 2-level disease, charges were similar between the TDR and fusion groups. The mean total charge for the 2-level TDR group was $55,524 versus $56,823 for the fusion group (P = 0.55). Operating room charges were $15,340 and $20,560, respectively, for the TDR and fusion groups (P = 0.0003). Surgeon fees and anesthesiologist charges based on Medicare reimbursement rates were $5857 and $525 for the fusion group, respectively, versus $2826 and $331 for the TDR group (P < 0.05 for each). Implant charges were significantly lower for the fusion group (mean, $18,460) than those for 2-level Synthes ProDisc ($27,600) (P < 0.05). Operative time averaged 387 minutes for fusion versus 242 minutes for TDR (P < 0.0001). EBL and length of stay were similar.
  
  
  CONCLUSIONS
  Patients undergoing 1- and 2-level ProDisc total disc replacement spent significantly less time in the OR and had less EBL than controls. Charges were significantly lower for TDR compared with circumferential fusions in the 1-level patient group, while charges were similar in the 2-level group.
authors.affiliation: Department of Orthopaedic Surgery, Spine Division, Hospital for Joint Diseases, New York, NY, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Levin
authors.forename: John A
authors.initials: JA
authors.lastname: Bendo
authors.forename: Martin
authors.initials: M
authors.lastname: Quirno
authors.forename: Thomas
authors.initials: T
authors.lastname: Errico
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldstein
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Spivak
mesh_terms: D000328:Adult; D000761:Anesthesia Department, Hospital / Q000191:economics; D019643:Arthroplasty, Replacement / Q000191:economics* / Q000295:instrumentation; D003362:Cost-Benefit Analysis; D005249:Fees and Charges; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007349:Insurance, Health, Reimbursement; D007403:Intervertebral Disc / Q000601:surgery*; D007902:Length of Stay / Q000191:economics; D017116:Low Back Pain / Q000191:economics / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D019736:Prostheses and Implants / Q000191:economics; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications* / Q000191:economics / Q000601:surgery; D013123:Spinal Fusion / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States