Minimally Invasive Transforaminal Lumbar Interbody Fusion: Cost of a Surgeon's Learning Curve

Area of Science:

• Spine surgery outcomes
• Surgical learning curves
• Health economics in spine procedures

Background:

• Minimally invasive transforaminal interbody fusion is a common technique for adult degenerative spine disease.
• This surgical approach has a steep learning curve, impacting efficiency and cost.
• Understanding the learning curve is crucial for optimizing surgical practice.

Purpose of the Study:

• To evaluate the impact of surgical experience on procedure time and cost for minimally invasive transforaminal interbody fusion.
• To quantify the learning curve and identify the number of procedures needed to achieve proficiency.
• To assess the economic implications of the learning experience in spine surgery.

Main Methods:

• Analysis of the first 100 consecutive minimally invasive transforaminal interbody fusion cases from a single surgeon.
• Multivariable linear regression models to assess the relationship between procedure order, operating time, and costs, adjusted for patient factors.
• K-means cluster analysis to determine the number of procedures required for proficiency.

Main Results:

• Procedure time and costs decreased significantly with successive cases.
• Each case was associated with an average reduction of 0.97 minutes in procedure time and $82.75 in costs.
• Proficiency was estimated at 58 procedures, with significant excess time and costs incurred during the learning phase.

Conclusions:

• Surgical proficiency in minimally invasive transforaminal interbody fusion leads to reduced procedure times and costs.
• The learning curve demonstrates a clear trend of increasing efficiency and cost-effectiveness with experience.
• Quantifying the learning curve is essential for understanding and managing the resources associated with adopting new surgical techniques.