Related Experiment Video
Updated: Sep 14, 2025
05:52
Novel Mini-open Transforaminal Lumbar Interbody Fusion
Published on: June 6, 2025
199
Experience Matters: An Application of the Operative Value Index for Lumbar Fusions
Danyal Quraishi1, Advith Sarikonda2, D Mitchell Self2
1Department of Surgery, Drexel University College of Medicine, Philadelphia, PA, USA. danyalquraishi@gmail.com.
Neurosurgical Review
|July 22, 2025
Summary
Experienced and high-volume spine surgeons reduce costs and improve outcomes in lumbar fusions. This study highlights how surgeon expertise and case volume enhance operative value, crucial for value-based care in neurosurgery.
Area of Science:
- Neurosurgery and Health Economics
- Value-based care models in surgical specialties
- Time-Driven Activity-Based Costing (TDABC) in healthcare
Background:
- Transitioning healthcare systems to value-based care necessitates understanding cost and outcome drivers in neurosurgery.
- Limited application of TDABC in neurosurgery for analyzing surgeon-specific impacts on costs and outcomes.
- Lumbar fusions are a key area to assess operative value due to significant cost and outcome variability.
Purpose of the Study:
- To assess the impact of surgeon experience and case volume on costs, clinical outcomes, and operative value in lumbar fusions using TDABC.
- To quantify the relationship between surgeon expertise, procedural volume, and patient outcomes (ODI) and cost-effectiveness (OVI).
- To provide insights for optimizing resource allocation and enhancing patient value in neurosurgical procedures.
Main Methods:
- Retrospective cohort study of 291 lumbar instrumented arthrodesis procedures (2017-2019).
- Variables: Surgeon experience (years), case volume (annual procedures), patient demographics, comorbidities, surgery type, levels fused.
- Cost data from electronic health records; outcomes measured by Oswestry Disability Index (ODI); operative value defined by Operative Value Index (OVI).
Main Results:
- Surgeons with ≥15 years of experience had lower costs ($16,071.78 vs. $22,259.71) and higher OVI (1.81 vs. 1.2).
- High-volume surgeons (≥100 cases/year) demonstrated greater ODI improvements (34.90 vs. 22.07) and higher OVI (2.22 vs. 1.01).
- Procedure type and levels fused significantly impacted both surgery costs and OVI (p < 0.001).
Conclusions:
- Surgeon experience (≥15 years) and high case volume (≥100 cases/year) are associated with enhanced operative value in lumbar fusions.
- Experienced surgeons reduce costs, while high-volume surgeons improve clinical outcomes (ODI) and cost-effectiveness (OVI).
- Specialization and maintaining high case volumes are recommended strategies to improve cost-effectiveness and patient outcomes in neurosurgery.
Keywords:
Bundled paymentsCase volumeHealth economicsHealthcare costsIntraoperative costsOperating room efficiencyOperative timesSpinal fusion surgerySurgeon experienceTime-Driven Activity-Based costing (TDABC)Transforaminal lumbar interbody fusion (TLIF)
