title: Reducing the cost and frequency of explantations associated with single-level anterior diskectomy and fusion at a single institution through education.
abstract: METHODS
  We prospectively evaluated the costs/frequency of explanted instrumentation (devices implanted but removed prior to closure) for all single-level anterior diskectomy (1-ADF) procedures performed in 2010 at a single institution before and after surgeon education.
  
  
  OBJECTIVE
  To determine whether surgeon education would reduce the costs/frequency of explantation for 1-ADF.
  
  
  BACKGROUND
  In 2009, we reported that the cost of explanted devices was 9.2% of the cost of implanted devices.
  
  
  METHODS
  The costs/frequencies of explantation for 1-ADF performed in 2010 at the same institution by the same surgeons were analyzed before and after surgeon education. From January through April, surgeons were unaware of concerns regarding explantation. At the end of April 2010, spinal surgeons were educated about explantation costs/frequency at 2 meetings. Explantation costs/frequencies for the first 4 months of 2010 were compared with those for the last 8 months as well as with the results from 2009.
  
  
  RESULTS
  Prior to surgeon education, instrumentation was explanted in 45.5% of the cases, whereas after education explantation occurred in 16% of the cases. The explantation rate (the number of explanted devices as a percentage of implanted devices) was lower after education for screws (12.5% vs. 7.7%), plates (9.4% vs. 0%), and allograft spacers (7.1% vs. 2.9%), and lower than for rates from 2009. In 2010, the overall cost of explanted devices as a percentage of implanted devices was also lower after surgeon education (5.8%) than before surgeon education in 2010 (20.0%) or 2009 (9.2%).
  
  
  CONCLUSIONS
  The frequency and cost of explanted instrumentation used to perform 1-ADF were reduced through surgeon education.
authors.affiliation: The Albert Einstein College of Medicine, Bronx, NY, USA. dch3@columbia.edu
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
authors.forename: Garry S
authors.initials: GS
authors.lastname: Schwall
authors.forename: Donald C
authors.initials: DC
authors.lastname: Hood
mesh_terms: D001860:Bone Plates / Q000191:economics; D001863:Bone Screws / Q000191:economics; D017046:Cost Savings / Q000191:economics / Q000379:methods; D017586:Diskectomy / Q000191:economics* / Q000193:education* / Q000295:instrumentation; D004502:Education, Medical, Continuing / Q000191:economics / Q000639:trends; D017048:Health Care Costs / Q000639:trends; D006801:Humans; D016268:Internal Fixators / Q000191:economics; D055959:Intervertebral Disc Degeneration / Q000191:economics / Q000601:surgery*; D011446:Prospective Studies; D017755:Prosthesis Fitting / Q000191:economics*; D019919:Prosthesis Implantation / Q000191:economics / Q000193:education; D013123:Spinal Fusion / Q000191:economics* / Q000193:education* / Q000295:instrumentation; D055009:Spondylosis / Q000191:economics / Q000601:surgery*