Mini-Open Thoracolumbar Corpectomy: Perioperative Outcomes and Hospital Cost Analysis Compared with Open Corpectomy

World Neurosurg. 2017 Mar;99:295-301. doi: 10.1016/j.wneu.2016.11.075. Epub 2016 Nov 25.

Abstract

Background: Standard open surgical management of thoracolumbar infection, trauma, and tumor is associated with significant morbidity. We compared perioperative and immediate postoperative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs.

Methods: We retrospectively reviewed medical records of all patients who underwent open or mini-open corpectomy. Demographics (age, sex, body mass index, primary diagnosis), operative data (length of surgery, estimated blood loss, blood transfusion), surgical level, preoperative and postoperative neurologic status (using American Spinal Injury Association Impairment Scale), immediate perioperative complications (within 30 days postoperatively), overall length of stay from admission, length of stay from surgery, and total direct hospital costs were tabulated and analyzed.

Results: The study included 43 patients, 20 (46.51%) undergoing open corpectomy and 23 (53.48%) undergoing mini-open corpectomy. Clinical and statistically significant findings in favor of mini-open corpectomy included lower estimated blood loss (1305 mL vs. 560 mL, P = 0.0072), less blood transfusion (241 mL vs. 667 mL, P = 0.029), shorter overall length of stay (7.2 days vs. 12.2 days, P = 0.047), and shorter surgery time (376 minutes vs. 295 minutes, P = 0.035) as well as lower total direct hospital cost ($34,373 vs. $45,376, P = 0.044). There was no statistically significant difference in postoperative complications between the 2 groups (medical complications 5% vs. 4.3%, P = 0.891; surgical complications 5% vs. 8.69%, P = 0.534).

Conclusions: Mini-open TL corpectomy is a safe, cost-effective, clinically effective, and less morbid alternative to standard open thoracotomy surgical techniques.

Keywords: Cost-effectiveness; Mini-open corpectomy; Open corpectomy; Perioperative outcome; Spine infection; Spine trauma; Spine tumor.

MeSH terms

  • Blood Loss, Surgical / statistics & numerical data
  • Blood Transfusion / economics
  • Blood Transfusion / statistics & numerical data
  • Cost-Benefit Analysis
  • Female
  • Hospital Costs*
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Lumbar Vertebrae / injuries
  • Lumbar Vertebrae / surgery*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / economics
  • Neurosurgical Procedures / methods*
  • Operative Time
  • Osteomyelitis / surgery*
  • Postoperative Complications / economics
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Spinal Diseases / surgery
  • Spinal Fractures / surgery*
  • Spinal Fusion
  • Spinal Neoplasms / secondary
  • Spinal Neoplasms / surgery*
  • Thoracic Vertebrae / injuries
  • Thoracic Vertebrae / surgery*
  • Treatment Outcome