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

Comron Saifi, Alejandro Cazzulino, Joseph Laratta, Akshay V Save, Jamal N Shillingford, Philip K Louie, Andrew J Pugely, Vincent Arlet, Comron Saifi, Alejandro Cazzulino, Joseph Laratta, Akshay V Save, Jamal N Shillingford, Philip K Louie, Andrew J Pugely, Vincent Arlet

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.

Keywords: degenerative disc disease; fusion; low back pain; lumbar; lumbar interbody fusion; spondylolisthesis; trauma.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Total number of posterior lumbar fusion and posterior lumbar interbody fusion procedures per year.
Figure 2.
Figure 2.
Total number of revision posterior lumbar fusion and revision posterior lumbar interbody fusion procedures per year.
Figure 3.
Figure 3.
Total estimated costs of posterior lumbar fusion and posterior/transverse lumbar interbody surgeries between 2011 and 2014 across the United States.
Figure 4.
Figure 4.
Total estimated costs of revision posterior lumbar fusion and revision posterior/transverse lumbar interbody surgeries between 2011 and 2014 across the United States.
Figure 5.
Figure 5.
Age distributions for posterior lumbar fusion and posterior/transverse lumbar interbody fusion procedures in the United States.
Figure 6.
Figure 6.
Revision burden percentage for posterior lumbar fusion and posterior/transverse lumbar interbody fusion procedures in the United States.

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