Utilization and Economic Impact of Posterolateral Fusion and Posterior/Transforaminal Lumbar Interbody Fusion Surgeries in the United States

Abstract

Study Design: Retrospective database study.Objective: To analyze the economic and age data concerning primary and revision posterolateral fusion (PLF) and posterior/ transforaminal lumbar interbody fusion (PLIF/TLIF) throughout the United States to improve value-based care and health care utilization. Methods:The National Inpatient Sample (NIS) database was queried by the International Classification of Diseases, Ninth Revision, Clinical Modification codes for patients who underwent primary or revision PLF and PLIF/TLIF between 2011 and 2014. Age and economic data included number of procedures, costs, and revision burden. The National Inpatient Sample database represents a 20% sample of discharges from US hospitals weighted to provide national estimates. Results: From 2011 to 2014, the annual number of PLF and PLIF/TLIF procedures decreased 18% and increased 23%, respectively, in the Unites States. During the same period, the number of revision PLF decreased 19%, while revision PLIF/TLIF remained relatively unchanged. The average cost of PLF was lower than the average cost of PLIF/TLIF. The aggregate national cost for PLF was more than $3 billion, while PLIF/TLIF totaled less than $2 billion. Revision burden (ratio of revision surgeries to the sum of both revision and primary surgeries) remained constant at 8.0% for PLF while it declined from 3.2% to 2.9% for PLIF/TLIF. Conclusion: This study demonstrated a steady increase in PLIF/TLIF, while PLF alone decreased. The increasing number of PLIF/ TLIF procedures may account for the apparent decline of PLF procedures. There was a higher average cost for PLIF/TLIF as compared with PLF. Revision burden remained unchanged for PLF but declined for PLIF/TLIF, implying a decreased need for revision procedures following the initial PLIF/TLIF surgery.

Process Evaluation of Lumbar Interbody Fusion Surgeries in Five Dutch Hospitals: A Qualitative Analysis

“…A possible limitation of this study is that qualitative research incorporating interviews is always susceptible to interpretation by the researchers. To limit personal interpretation and to increase reflexivity, we: (1) included participants from different perspectives and different hospitals; (2) used open-ended questions and asked for additional information;…”

“…This number is expected to double again by 2050 [1]. Ageing of the population is one of the most prominent factors by which the number of instrumented spine surgeries has increased and will increase even further in the future [2,3]. Therefore, it is of significant importance to analyse, evaluate and eventually optimise the efficiency of the healthcare process and patient satisfaction [4].…”

Evidence-based medicine and clinical decision-making in spine surgery

“…According to the study's supplementary appendix, although 90% of the fusion procedures were instrumented posterolateral fusions, only 6 cases were submitted to interbody fusion. It should be noted that, at least in North America, a substantial proportion of instrumented lumbar fusion procedures involves an interbody cage (through either TLIF, ALIF or XLIF/DLIF/OLIF) [18] , techniques which have been associated with higher fusion rates and greater restoration of foraminal height and segmental lordosis.…”

Lumbar spine fusion outcomes using a cellular bone allograft with lineage-committed bone-forming cells in 96 patients

“…While some patients find relief from noninvasive interventions, spine surgery may be indicated when these treatments are not successful. Instrumented posterior lumbar fusion (IPLF) is one such surgical procedure often performed for spondylolisthesis, degenerative lumbar disc, and facet arthropathy [ 2 ]. In recent years, some studies have found improved fusion and functional outcomes with the addition of interbody devices, such as with transforaminal interbody fusion (TLIF), leading to their increased use [ 3 , 4 ].…”