Cost of Lateral Lumbar Interbody Fusion in the Elderly

Presented at SMISS Annual Forum 2018
By Nima Alan
With Jian Shen MD, PhD,

Disclosures: Nima Alan None Jian Shen MD, PhD B; K2M. C; Joimax.,


With continuously rising healthcare costs, spine surgeons have to demonstrate the clinical benefit of any given procedure in a financially conscious fashion.


We performed a direct cost comparison of lateral lumbar interbody fusion (LLIF) between two cohorts - those above 65 and those below 65 years of age.


Financial data of 116 patients who underwent LLIF between 2013 and 2017 were analyzed. The pre- and postoperative values for the Oswestry Disability Index (ODI) were also analyzed to compare outcomes. The total cost of care was based on the length of hospitalization, anesthesia, operative, laboratory, imaging, and administrative costs. Correlation among age, number of levels fused, and length of hospital stay was performed.


Seventy-six patients under 65 and forty patients above 65 years of age were included. Postoperatively, improvement in ODI was observed in 85% of patients > 65 years and 84% of the younger cohort (p = 0.59). The mean cost in patients above 65 was $20,421 which was significantly higher than in their younger counterpart, $17,099 (p=0.022). Patients above 65 had a longer length of hospitalization, 2.18 days, compared to 1.5 days in younger patients (p=0.027); this was associated with higher costs (p=0.001). The number of levels fused was significantly higher in the elderly patient group (p=0.0001). Matching patients based on the number of levels fused demonstrated that laboratory (p=0.001), imaging (p=0.001), administrative (p=0.02), and anesthesia (p=0.003) expenses where significantly higher for elderly patients.


Per level of fusion via LLIF, costs were higher in patients over the age of 65. Higher expenses were due to non-operative factors including laboratory, anesthesia, imaging and administrative costs.