title: Cost-utility of minimally invasive versus open transforaminal lumbar interbody fusion: systematic review and economic evaluation.
abstract: OBJECTIVE
  To assess the cost-utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies.
  
  
  METHODS
  Relevant articles were identified from six electronic databases. Predefined end points were extracted and meta-analysis conducted from the identified studies.
  
  
  RESULTS
  For each study, the direct hospital cost for MI-TLIF was found to be less than that of open-TLIF. When these outcomes were pooled, direct hospital costs were found to be significantly lower in the MI-TLIF group [weighted mean difference (WMD), -$2820; I (2) = 61 %; P < 0.00001]. MI-TLIF was also associated with shorter hospitalization (WMD, 0.99; 95 % CI -1.81, -0.17; I (2) = 96 %; P = 0.02), trend toward reduced complications (relative risk 0.53; 95 % CI 0.23, 1.06; I (2) = 0 %; P = 0.07), and reduced blood loss (WMD, -246.40 mL; I (2) = 98 %; P = 0.003), but was not associated with a significant difference in operation time (WMD, -67.05; 95 % CI -169.44, 35.35; I (2) = 100 %; P = 0.20).
  
  
  CONCLUSIONS
  From the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective.
authors.affiliation: Department of Neurosurgery, University of New South Wales, High Street, Randwick, NSW, Australia. kphan.vc@gmail.com.|Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia. kphan.vc@gmail.com.|NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. kphan.vc@gmail.com.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
authors.forename: Jarred A
authors.initials: JA
authors.lastname: Hogan
authors.affiliation: Department of Neurosurgery, University of New South Wales, High Street, Randwick, NSW, Australia. ralphmobbs@hotmail.com.|Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, NSW, 2031, Australia. ralphmobbs@hotmail.com.|NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. ralphmobbs@hotmail.com.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D061646:Operative Time; D011183:Postoperative Complications; D013123:Spinal Fusion / Q000191:economics* / Q000379:methods
keywords: Cost; Cost-effectiveness; Cost–utility; Minimally invasive; Transforaminal lumbar interbody fusion