Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors.
BACKGROUND
Minimally invasive spinal surgery (MIS) has emerged as a clinically effective tool but its cost-effectiveness remains unclear. No studies have compared MIS vs open surgical techniques for the treatment of intradural extramedullary (IDEM) tumors.


OBJECTIVE
To analyze and compare open and MIS techniques for resection of IDEM tumors, with focus on perioperative costs.


METHODS
Retrospective analysis of a prospectively collected database including 35 IDEM patients (18 open, 17 MIS). Perioperative data, hospital costs, and hospital and physician charges for in-hospital services associated with the index surgical procedure and readmissions within 90 days were compared.


RESULTS
Mean estimated blood loss, operative time, preoperative hospital charges, and physician fees were similar between open and MIS techniques. Patient and tumor characteristics were similar between groups. MIS cases were associated with shorter intensive care unit and floor stay. There were 3 complications in the open group, requiring 2 readmissions and 1 reoperation. Hospital costs ($21 307.80 open, $15 015.20 MIS, P < .01), and postoperative ($75 383.48 open, $56 006.88 MIS, P < .01) and total charges ($100 779.38 open, $76 100.92 MIS, P < .01) were significantly lower in the MIS group. There were no tumor recurrences in either group. All patients except for one in the open group maintained or improved their Nurick score.


CONCLUSIONS
Both MIS and open techniques were able to adequately treat IDEM tumors. Reductions in complication rate and intensive care unit and hospital stay led to a decrease in hospital costs of almost 30% in the MIS group. MIS resection of IDEM tumors is not only an effective and safe option, but allows faster hospital discharge and significant cost savings.
Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
Ricardo B V
RB
Fontes
Joshua T
JT
Wewel
John E
JE
OʼToole
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D017046:Cost Savings; D016208:Databases, Factual; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics*; D000069471:Neurosurgeons / Q000191:economics; D019635:Neurosurgical Procedures / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D019990:Perioperative Care / Q000191:economics*; D012189:Retrospective Studies; D013120:Spinal Cord Neoplasms / Q000191:economics* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult