Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors
Abstract 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...
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Veröffentlicht in: | Neurosurgery 2016-04, Vol.78 (4), p.531-539 |
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creator | Fontes, Ricardo B. V. Wewel, Joshua T. O'Toole, John E. |
description | Abstract
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.
CONCLUSION:
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. |
doi_str_mv | 10.1227/NEU.0000000000001079 |
format | Article |
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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.
CONCLUSION:
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.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/NEU.0000000000001079</identifier><identifier>PMID: 26509643</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical ; Cancer ; Cost control ; Cost Savings ; Databases, Factual ; Female ; Hospital Costs ; Humans ; Intensive care ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures - economics ; Neurosurgeons - economics ; Neurosurgery ; Neurosurgical Procedures - economics ; Patient Readmission - economics ; Perioperative Care - economics ; Retrospective Studies ; Spinal cancer ; Spinal cord ; Spinal Cord Neoplasms - economics ; Spinal Cord Neoplasms - surgery ; Treatment Outcome ; Tumors ; Young Adult</subject><ispartof>Neurosurgery, 2016-04, Vol.78 (4), p.531-539</ispartof><rights>2015 by the Congress of Neurological Surgeons 2015</rights><rights>Copyright © by the Congress of Neurological Surgeons</rights><rights>2015 by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4249-f536603449907156c4f0ba5701a1f0f7910d1fdda35314b1482d4db47b1115783</citedby><cites>FETCH-LOGICAL-c4249-f536603449907156c4f0ba5701a1f0f7910d1fdda35314b1482d4db47b1115783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26509643$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fontes, Ricardo B. V.</creatorcontrib><creatorcontrib>Wewel, Joshua T.</creatorcontrib><creatorcontrib>O'Toole, John E.</creatorcontrib><title>Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors</title><title>Neurosurgery</title><addtitle>Neurosurgery</addtitle><description>Abstract
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.
CONCLUSION:
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Blood Loss, Surgical</subject><subject>Cancer</subject><subject>Cost control</subject><subject>Cost Savings</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Hospital Costs</subject><subject>Humans</subject><subject>Intensive care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Minimally Invasive Surgical Procedures - economics</subject><subject>Neurosurgeons - economics</subject><subject>Neurosurgery</subject><subject>Neurosurgical Procedures - economics</subject><subject>Patient Readmission - economics</subject><subject>Perioperative Care - economics</subject><subject>Retrospective Studies</subject><subject>Spinal cancer</subject><subject>Spinal cord</subject><subject>Spinal Cord Neoplasms - economics</subject><subject>Spinal Cord Neoplasms - surgery</subject><subject>Treatment Outcome</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkU9v1DAQxS0EotvCN0DIEhcuaf1nHG-O1WpLV2opglbiZjmJo6Z44-CJt91vX6-2VKgXmIvn8HtPz_MI-cDZMRdCn3xd3hyzv4YzXb0iM64EFMCAvSYzxmFeyKr8eUAOEe8yU4KevyUHolSsKkHOCH5zsQ-ji3bqN44uAk70dLB-iz3S0NHLfujX1vstXQ0biztmg_RqdAP97tA1Ux-GHbcapmjbFK2ny4e8rl2bvLdxS3-MffbLzrGl12kdIr4jbzrr0b1_eo_IzdnyenFeXFx9WS1OL4oGBFRFp2RZMglQVUxzVTbQsdoqzbjlHet0xVnLu7a1UkkOdf6raKGtQdecc6Xn8oh83vuOMfxODiez7rFxOdbgQkLDtQYlmRAyo59eoHchxZwbjZBKK10BKzMFe6qJATG6zowxXyduDWdmV4rJpZiXpWTZxyfzVOe7PIv-tJCB-R64D35yEX_5dO-iuXXWT7f_8j7ZS0Ma_y_NI32IpTA</recordid><startdate>20160401</startdate><enddate>20160401</enddate><creator>Fontes, Ricardo B. V.</creator><creator>Wewel, Joshua T.</creator><creator>O'Toole, John E.</creator><general>Oxford University Press</general><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20160401</creationdate><title>Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors</title><author>Fontes, Ricardo B. V. ; Wewel, Joshua T. ; O'Toole, John E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4249-f536603449907156c4f0ba5701a1f0f7910d1fdda35314b1482d4db47b1115783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Blood Loss, Surgical</topic><topic>Cancer</topic><topic>Cost control</topic><topic>Cost Savings</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Hospital Costs</topic><topic>Humans</topic><topic>Intensive care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Minimally Invasive Surgical Procedures - economics</topic><topic>Neurosurgeons - economics</topic><topic>Neurosurgery</topic><topic>Neurosurgical Procedures - economics</topic><topic>Patient Readmission - economics</topic><topic>Perioperative Care - economics</topic><topic>Retrospective Studies</topic><topic>Spinal cancer</topic><topic>Spinal cord</topic><topic>Spinal Cord Neoplasms - economics</topic><topic>Spinal Cord Neoplasms - surgery</topic><topic>Treatment Outcome</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fontes, Ricardo B. V.</creatorcontrib><creatorcontrib>Wewel, Joshua T.</creatorcontrib><creatorcontrib>O'Toole, John E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fontes, Ricardo B. V.</au><au>Wewel, Joshua T.</au><au>O'Toole, John E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors</atitle><jtitle>Neurosurgery</jtitle><addtitle>Neurosurgery</addtitle><date>2016-04-01</date><risdate>2016</risdate><volume>78</volume><issue>4</issue><spage>531</spage><epage>539</epage><pages>531-539</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>Abstract
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.
CONCLUSION:
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.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>26509643</pmid><doi>10.1227/NEU.0000000000001079</doi><tpages>9</tpages></addata></record> |
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subjects | Adult Aged Aged, 80 and over Blood Loss, Surgical Cancer Cost control Cost Savings Databases, Factual Female Hospital Costs Humans Intensive care Male Middle Aged Minimally Invasive Surgical Procedures - economics Neurosurgeons - economics Neurosurgery Neurosurgical Procedures - economics Patient Readmission - economics Perioperative Care - economics Retrospective Studies Spinal cancer Spinal cord Spinal Cord Neoplasms - economics Spinal Cord Neoplasms - surgery Treatment Outcome Tumors Young Adult |
title | Perioperative Cost Analysis of Minimally Invasive vs Open Resection of Intradural Extramedullary Spinal Cord Tumors |
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