title: Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis.
abstract: BACKGROUND
  Surgical site infection (SSI) in the setting of lumbar fusion is associated with significant morbidity and medical resource utilization. To date, there have been no studies conducted with sufficient power to directly compare the incidence of SSI following minimally invasive (MIS) vs. open TLIF procedures. Furthermore, studies are lacking that quantify the direct medical cost of SSI following fusion procedures. We set out to determine the incidence of SSI in patients undergoing MIS vs. open TLIF reported in the literature and to determine the direct hospital cost associated with the treatment of SSI following TLIF at our institution.
  
  
  METHODS
  A systematic Medline search was performed to identify all published studies assessing SSI after MIS or open TLIF. The cumulative incidence of SSI was calculated from all reported cohorts and compared between MIS vs. open TLIF. In order to determine the direct hospital costs associated with the treatment of SSI following TLIF, we retrospectively reviewed 120 consecutive TLIFs performed at our institution, assessed the incidence of SSI, and calculated the SSI-related hospital costs from accounting and billing records.
  
  
  RESULTS
  To date, there have been 10 MIS-TLIF cohorts (362 patients) and 20 open-TLIF cohorts (1 133 patients) reporting incidences of SSI. The cumulative incidence of reported SSI was significantly lower for MIS vs. open-TLIF (0.6% vs. 4.0%, p=0.0005). In our experience with 120 open TLIF procedures, SSI occurred in 6 (5.0%) patients. The mean hospital cost associated with the treatment of SSI following TLIF was $ 29,110 in these 6 cases. The 3.4% decrease in reported incidence of SSI for MIS vs. open-TLIF corresponds to a direct cost savings of $ 98,974 per 100 MIS-TLIF procedures performed.
  
  
  CONCLUSIONS
  Post-operative wound infections following TLIF are costly complications. MIS vs. open TLIF is associated with a decreased reported incidence of SSI in the literature and may be a valuable tool in reducing hospital costs associated with spine care.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: S L
authors.initials: SL
authors.lastname: Parker
authors.forename: O
authors.initials: O
authors.lastname: Adogwa
authors.forename: T F
authors.initials: TF
authors.lastname: Witham
authors.forename: O S
authors.initials: OS
authors.lastname: Aaronson
authors.forename: J
authors.initials: J
authors.lastname: Cheng
authors.forename: M J
authors.initials: MJ
authors.lastname: McGirt
mesh_terms: D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods / Q000639:trends; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods*; D013530:Surgical Wound Infection / Q000191:economics* / Q000453:epidemiology* / Q000517:prevention & control