Economic Performance of Oblique Lateral Lumbar Interbody Fusion (OLLIF) with a Focus on Hospital Throughput Efficiency

Presented at SMISS Annual Forum 2016
By Hamid Abbasi MD, PhD, FACS, FAANS
With Christopher Murphy

Disclosures: Hamid Abbasi MD, PhD, FACS, FAANS A; AMW LLC., Christopher Murphy A; AMW LLC.

Introduction

Low back pain affects up to 80% of all people during their lifetime. Standard treatment for lower back pain, interbody fusion, in an invasive procedure that requires stripping the muscles and soft tissue. This leads to increased blood loss and long recovery time. (TLIF) was developed as a treatment for disc disorders in 1982. Oblique posterior lateral lumbar fusion (OLLIF) is a surgical procedure designed for a minimally invasive spinal fusion and allows for lumbar spine fusion through a single 10-15 mm incision, with faster surgery times and easier approach than any previous technique. This procedure decreases the recovery time required in a traditional spinal fusion surgery.In recent years, the rate of disability due to low back pain has increased dramatically, and consequently, costs have skyrocketed. Advancements in the surgical treatment of lower back pain could contribute to lower health care costs. We present perioperative outcome data from
69 OLLIF vs. 55 open TLIFs on 125 levels done by the same surgeon, and monetize quantifiable differences in the resource utilization between the two procedures.

Aims/Objectives

Standard conversion factors were used and values reported based on the levels (1-4) addressed at surgery. One level surgery time and surgical expense were reduced in the OLLIF population. Inpatient costs and length of stay were also reduced. Per case, reduced resource consumption suggests lower total hospital costs. Reduced surgical time and LOS can result in greater patient throughput per operating room and patient bed for OLLIF patients in hospitals that have resourced constrained environments. 

Methods

This was a retrospective case series including 69 OLLIF patients and 55 open TLIF controls. The exempt status of this study, in accordance with FDA regulations, was approved by the Pearl Institutional Review Board. 

Results

Summary statistics for the two study groups are shown below. There were no significant differences between the groups in either BMI or age. The only exception was that OLLIF three level patients were significantly older than their counterparts in the TLIF comparison group. 

Conclusions

The cost reductions and faster recovery times associated with the OLLIF procedure make it an appealing alternative to the traditional open fusions available for patient and insurance providers. The reduction in the use of these key hospital resources suggests that hospitals that are constrained by OR or hospital bed availability may be able to achieve greater throughput efficiency by increasing the overall percentage of patients receiving the OLLIF surgery.