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Updated: Jan 17, 2026

Novel Mini-open Transforaminal Lumbar Interbody Fusion
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Can We Finally Quantify Value for Lumbar Fusions? Introducing the Operative Value Index (OVI).

Advith Sarikonda1, Ashmal Sami1, Adam Leibold1

  • 1Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience.

Clinical Spine Surgery
|January 15, 2026
PubMed
Summary

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Which spine surgeries belong in the ambulatory surgical center? Determining economic viability using time-driven activity-based costing.

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Defining the value of elective lumbar fusion: a systematic review of existing methodologies and framework for the Operative Value Index.

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This summary is machine-generated.

This study introduces new metrics combining patient outcomes and costs to measure the value of transforaminal lumbar interbody fusions (TLIFs). Some surgeons demonstrated higher value, highlighting variations in spine surgery efficiency.

Area of Science:

  • Spine surgery
  • Health economics
  • Value-based care

Background:

  • Patient-reported outcomes (PROs) and cost analyses are crucial in spine surgery research.
  • Few studies have integrated PROs with time-driven activity-based costing (TDABC) to assess surgical value.
  • Quantifying surgical value is essential for improving healthcare efficiency and patient outcomes.

Purpose of the Study:

  • To integrate patient-reported outcomes (PROs) with time-driven activity-based costing (TDABC) for quantifying value in single-level transforaminal lumbar interbody fusions (TLIFs).
  • To assess value at both the surgeon-level and procedure-level.
  • To identify variations in surgical value among different surgeons.

Main Methods:

  • Retrospective analysis of 142 single-level TLIFs performed by neurosurgeons.
Keywords:
neurosurgeryoutcomestime-driven activity-based costingvalue-based care

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  • Intraoperative time-driven activity-based costing (TDABC) to determine direct and indirect costs.
  • Oswestry Disability Index (ODI) collected pre- and post-operatively; operative value index (OVI) and unit price for outcomes (UPO) calculated.
  • Generalized linear mixed models (GLMM) used to analyze surgeon-level variability in OVI.

    • Main Results:

    • The average cost for a one-level TLIF was $11,984.
    • The average operative value index (OVI) was 3.2, and unit price for outcomes (UPO) was $643.
    • Surgeons categorized as 'other surgeons' showed significantly lower OVI compared to Surgeon A (P<0.05), indicating lower value.

    Conclusions:

    • Novel metrics combining diagnosis-specific PROs and TDABC effectively quantify value in single-level TLIFs.
    • These metrics can assist stakeholders in identifying factors contributing to variations in value among spine surgeons.
    • The findings underscore the importance of assessing both clinical outcomes and cost-efficiency in surgical practice.