title: Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost-utility analysis.
abstract: BACKGROUND
  Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for lumbar spondylolisthesis allows for the surgical treatment of back/leg pain while minimizing tissue injury and accelerating the patient's recovery. Although previous results have shown shorter hospital stays and decreased intraoperative blood loss for MIS versus open TLIF, short- and long-term outcomes have been similar. Therefore, we performed comparative effectiveness and cost-utility analysis for MIS versus open TLIF.
  
  
  METHODS
  A total of 100 patients (50 MIS, 50 open) undergoing TLIF for lumbar spondylolisthesis were prospectively studied. Back-related medical resource use, missed work, and quality-adjusted life years were assessed. Cost of in-patient care, direct cost (2-year resource use × unit costs based on Medicare national allowable payment amounts), and indirect cost (work-day losses × self-reported gross-of-tax wage rate) were recorded, and the incremental cost-effectiveness ratio was calculated.
  
  
  RESULTS
  Length of hospitalization and time to return to work were less for MIS versus open TLIF (P = 0.006 and P = 0.03, respectively). MIS versus open TLIF demonstrated similar improvement in patient-reported outcomes assessed. MIS versus open TLIF was associated with a reduction in mean hospital cost of $1758, indirect cost of $8474, and total 2-year societal cost of $9295 (P = 0.03) but similar 2-year direct health care cost and quality-adjusted life years gained.
  
  
  CONCLUSIONS
  MIS TLIF resulted in reduced operative blood loss, hospital stay and 2-year cost, and accelerated return to work. Surgical morbidity, hospital readmission, and short- and long-term clinical effectiveness were similar between MIS and open TLIF. MIS TLIF may represent a valuable and cost-saving advancement from a societal and hospital perspective.
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: Scott L
authors: SL
authors: Parker
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: Stephen K
authors: SK
authors: Mendenhall
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: David N
authors: DN
authors: Shau
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: Scott L
authors: SL
authors: Zuckerman
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: Saniya S
authors: SS
authors: Godil
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA.
authors: Joseph S
authors: JS
authors: Cheng
authors: Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Spinal Column Surgical Quality and Outcomes Research Laboratory, Nashville, Tennessee, USA. Electronic address: matt.mcgirt@vanderbilt.edu.
authors: Matthew J
authors: MJ
authors: McGirt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005471:Fluoroscopy; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009294:Narcotics / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D019990:Perioperative Care; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D062707:Return to Work; D013123:Spinal Fusion / Q000379:methods*; D013168:Spondylolisthesis / Q000150:complications / Q000191:economics / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D009294:Narcotics
keywords: Comparative effectiveness; Cost-utility; Spondylolisthesis; Transforaminal lumbar interbody fusion