TLIF-MIS VS TLIF-OPEN: COST EVALUATION

ABSTRACT Objective: To evaluate the direct costs of transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS) or open technique (OPEN). Methods: The present study is descriptive and retrospective. Sixteen patients with degenerative spinal pathology operated on with the TLIF MIS technique and TLIF OPEN were included over a 13-month period. Days of hospital stay, blood loss, surgical time, medical care and costs were compared. Results: The mean number of days of hospital stay was 6.7 ± 4.3 days with TLIF MIS and 11.1 ± 6.5 days with TLIF OPEN. The blood loss was 307 ± 81.6 ml (range 200400 ml) with TLIF MIS and 803 ± 701.3 ml (range 200-1800 ml) with TLIF OPEN. The surgical time was 320 ± 92.6 minutes (range 210-500 minutes) in TLIF MIS and 372 ± 95.2 minutes (280-540 minutes) in TLIF OPEN. Conclusions: The difference in surgical costs and time between the two procedures was not statistically significant. There was less bleeding during the TLIF-MIS surgery, as well as a correlation between shorter days of hospital stay proportional to bleeding and surgical time, which translates into a reduction in the cost of these items. Level of Evidence III; Analysis based on alternatives and limited costs.

摘要
目的：评估经椎间孔腰椎椎体间融合术（transforaminal lumbar interbody fusion, TLIF）分别采用微创手术（minimally invasive surgery, MIS）与开放手术（open technique, OPEN）的直接治疗成本。
方法：本研究为描述性回顾性研究。纳入13个月周期内接受TLIF微创手术与TLIF开放手术治疗的16例退行性脊柱病变患者。比较两组患者的住院天数、失血量、手术时长、医疗护理情况及治疗成本。
结果：TLIF微创手术组的平均住院天数为6.7±4.3天，TLIF开放手术组为11.1±6.5天。TLIF微创手术组失血量为307±81.6 ml（范围200~400 ml），TLIF开放手术组为803±701.3 ml（范围200~1800 ml）。TLIF微创手术组手术时长为320±92.6分钟（范围210~500分钟），TLIF开放手术组为372±95.2分钟（范围280~540分钟）。
结论：两种术式的手术成本与手术时长差异无统计学意义。TLIF微创手术术中失血量更少，且住院天数更短，该差异与失血量及手术时长呈正相关，可降低此类相关项目的治疗成本。
证据等级：Ⅲ级；基于替代方案与有限成本的分析。