A comparison of perioperative costs and outcomes in patients with and without workers' compensation claims treated with minimally invasive or open transforaminal lumbar interbody fusion

Abstract

Study design: A nonrandomized, nonblinded prospective review.

Objective: To analyze intraoperative, immediate postoperative, and financial outcomes in worker's compensation (WC) and non-WC patients undergoing either an open or a minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF).

Summary of background data: Few studies have analyzed outcomes in a WC population of MIS TLIFs.

Methods: A total of 66 consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open and 33 MIS). Twenty-four total WC patients were identified (11 MIS and 13 open). Patients in either cohort (MIS/open) were matched according to insurance status (WC) and medical comorbidities (Charleston disability index). Every patient in this study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (min), length of stay (d), estimated blood loss (mL), anesthesia time (min), visual analogue scale scores, and hospital cost/payment amount were assessed (MIS/open and work-comp versus non-work comp).

Results: There were no statistically significant differences between MIS WC and non-WC TLIFs with respect to surgical time, length of stay, estimated blood loss, visual analogue scale scores, and anesthesia time. There were no statistically significant differences between open WC and non-WC TLIF patients in all of the same above-mentioned parameters. There were significant differences between MIS (WC and non-WC) and open (WC and non-WC) TLIFs in clinical outcomes. There were statistically significant differences in total costs amounts between WC MIS TLIF and WC open TLIF ($28,060 vs. $33,862, respectively; P = 0.0311) and non-WC MIS TLIF versus non-WC open TLIF groups ($29,429 vs. $32,998, respectively; P = 0.0001).

Conclusion: Contrary to popular belief, immediate outcomes and hospitalizations between non-WC and WC populations did not differ regardless of surgical technique (MIS/open). Differences occurred in improved outcomes with an MIS TLIF versus an open TLIF even in a WC environment. MIS TLIF WC and non-WC patient hospital costs were lower than their open TLIF counterparts.