Comparison of Value Per Operative Time Between Anterior Lumbar Interbody Fusion and Lumbar Disc Arthroplasty: A Propensity Score-Matched Analysis   — The International Society for the Study of the Lumbar Spine
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  2. SESSION #6 - SURGERY II: FUSION AND MINIMALLY INVASIVE SURGERY
  3. Comparison of Value Per Operative Time Between Anterior Lumbar Interbody Fusion and Lumbar Disc Arthroplasty: A Propensity Score-Matched Analysis  

Comparison of Value Per Operative Time Between Anterior Lumbar Interbody Fusion and Lumbar Disc Arthroplasty: A Propensity Score-Matched Analysis   (#31)

Junho Song 1 2 , Austen Katz 1 , Terence Ng 1 , Eric Neufeld 1 , Nipun Sodhi 1 , Jeff Silber 1 , David Essig 1 , Sheeraz Qureshi 2 , Sohrab Virk 1
  1. Northwell Health Long Island Jewish Medical Center, New Hyde Park, NY, United States
  2. Hospital for Special Surgery, New York, NY, United States

Introduction: Fusion procedures, such as anterior lumbar interbody fusion (ALIF), have been the standard for surgical management of lumbar degenerative disc disease1. Lumbar disc arthroplasty (LDA) is a more novel technique which has been shown to be a highly effective alternative to fusion2, 3. It has been suggested that the motion-preserving nature of disc arthroplasty provides a unique benefit of reduction in adjacent segment disease4. Despite the growing evidence demonstrating its effectiveness, LDA rates have not increased significantly in recent years5, 6. A likely contributing factor is insurers’ denial of coverage due to fear of late complications, reoperations, and unknown secondary costs7, 8. Although the cost analyses of LDA have been performed, no prior study has compared the physician reimbursement rates of lumbar fusion and LDA9. Therefore, the aim of this study was to compare the relative value units (RVUs) per minute of ALIF and LDA.

Methods: This retrospective cohort study utilizes data obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent ALIF or LDA between 2011 and 2019 were identified and included based on Current Procedural Terminology (CPT) codes 22558 and 22857, respectively. Exclusion criteria included multilevel, revision, emergency, non-elective, deformity procedures, intraspinal lesion, concomitant cervical procedures, laminectomy, laminotomy, and other posterior procedures. Patients with missing operation time, reoperation, and readmission data were also removed to prevent biases in the results. Statistical analysis was performed using SPSS software (version 28, IBM, Armonk, New York). Propensity score matching analysis was performed with a match tolerance of 0.01 according to demographic characteristics, comorbidities, and preoperative laboratory values. Matched groups were compared via Fisher’s exact test and independent t-test for categorical and continuous variables, respectively.

Results: The total cohort prior to matching consisted of 6,722 patients. 502 patients who underwent ALIF were matched with 591 patients who underwent LDA via propensity score matching. There were no differences in sex, race, and ethnicity between the matched groups, but patients in the ALIF group were significantly older on average (48.4 years vs. 43.8 years, p<0.001). Hypertension requiring medication (33.9% vs. 25.4%, p=0.003), chronic steroid use (2.0% vs. 0.3%, p=0.032), and ASA class of 3 or greater (26.7% vs. 21.0%, p=0.032) were more common in the ALIF group compared to LDA group (Table 1). Mean RVUs per minute was significantly higher for ALIF compared to LDA (0.431 vs. 0.302, p<0.001). In addition, LDA was associated with significantly higher readmission (3.4% vs. 0.0%, p<0.001) and reoperation (2.0% vs. 0.4%, p=0.027) rates, while morbidity rates were statistically similar (3.6% vs. 2.8%, p=0.496). No differences in rates of individual complications were observed (Table 2).

Conclusion: ALIF was associated with significantly higher RVUs per minute compared to LDA. LDA was associated with higher 30-day readmission and reoperation rates. These findings provide valuable evidence for assessing the physician reimbursement and outcomes of surgical treatment options for lumbar degenerative disc disease.

 

 

 

 
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