Cost and operating room time savings with single-position prone lateral lumbar interbody circumferential fusion

The objective of this study was to determine efficiencies associated with dual-position versus single-position lateral lumbar interbody fusion (LLIF).

Billing databases were queried for LLIF procedures performed by a single surgeon at a high-volume tertiary care center. Case-specific costs for each procedure were collected. Cases were matched by the number of levels treated. One-level and 2-level LLIFs with percutaneous pedicle screw (PPS) fixation (LLIF+PPS) using a single vendor system were included. Length of stay, operative time, and operative costs were compared for dual-position and single-position LLIF cases using continuous and categorical variable comparisons.

Among 9 patients with 1-level LLIF+PPS, dual-position LLIF+PPS (n = 3) compared with single-position LLIF+PPS (n = 6) was associated with similar mean lengths of stay (2.0 vs 2.2 days), longer operating room time (160.1 vs 149.7 minutes), and greater mean costs for operating room staff and supplies ($1347 vs $1263); however, the differences were not statistically significant. Time-based anesthesiology costs were higher for dual-position LLIF+PPS than for single-position LLIF+PPS ($741 vs $521, p = 0.03). Among 8 patients with 2-level LLIF+PPS, patients undergoing dual-position (n = 5) and single-position (n = 3) LLIF+PPS had similar mean lengths of stay (1.2 vs 1.5 days). However, dual-position surgery was associated with a longer mean operating room time (257.8 vs 182.3 minutes, p = 0.03), greater mean operating room cost ($2275 vs $1352, p = 0.02), and greater time-based cost of anesthesiology coverage ($864 vs $644, p = 0.01).

In this cohort of patients undergoing 1- and 2-level LLIF+PPS, single-position surgery was associated with shorter operating room time, lower operating room costs, and similar postoperative hospital length of stay when compared with dual-position surgery for a similar pathology.