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  • Perioperative cost analysis of minimally-invasive versus open resection of intradural-extramedullary spinal cord tumors

    Final Number:

    Ricardo B. V. Fontes MD, PhD; Joshua Thomas Wewel MD; John E. O'Toole MD, MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Minimally-invasive surgery (MIS) has emerged as a clinically effective alternative for the treatment of several spine pathologies but cost-effectiveness remains under debate. No studies have compared MIS versus open surgical techniques for the treatment of intradural-extramedullary (IDEM) tumors. Our objective is to analyze our experience with both techniques and compare acute in-hospital costs.

    Methods: Retrospective analysis of a prospectively-collected database identified 35 IDEM patients operated by the senior author (18 open, 17 MIS). Patient demographics, comorbidity profile and Nurick score were similar between both groups. Perioperative data, hospital costs and hospital and physician charges for in-hospital services associated with the index surgical procedure and eventual readmissions within 90 days were compiled and compared for both surgical techniques.

    Results: Most cases involved schwannomas (7 open, 8 MIS) and meningiomas (6 open, 5 MIS). Mean estimated blood loss (135.0 versus 90.3mL, p=.08) and operative time (170.8 versus 162.1 minutes, p=.61), preoperative hospital charges and surgeon’s fees were similar between groups. There were 3 complications in the open group, requiring two readmissions and one reoperation. MIS cases were associated with shorter ICU and floor stay (p<.05). Hospital costs ($21,307.80 open, $15,015.20 MIS, p<.01), postoperative ($75,383.48 open, $56,006.88 MIS, p<.01) and total charges ($100,779.38 open, $76,100.92 MIS, p<.01) were significantly lower in the MIS group.

    Conclusions: Both MIS and open techniques were able to adequately treat IDEM tumors. Perioperative parameters such as blood loss and operative time were similar but patients undergoing MIS resection had shorter ICU and postoperative hospital stays and fewer complications. This reduction in hospital stay led to a reduction in hospital costs of almost 30% for MIS technique. MIS resection of IDEM tumors is not only a safe option but allows faster discharges and significant cost savings.

    Patient Care: MIS techniques afford satisfactory results for the treatment of intradural extramedullary tumors, equivalent to open resection, with fewer complications and results in significant cost savings.

    Learning Objectives: - Recognize the feasibility of MIS techniques for treatment of intradural extramedullary spine tumors - Understand that while perioperative parameters were similar in both groups, MIS allowed faster discharges and fewer complications - The two above premises resulted in acute cost savings of almost 30% with the use of MIS techniques


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