Reducing the cost and frequency of explantations associated with single-level anterior diskectomy and fusion at a single institution through education.

STUDY DESIGN: We prospectively evaluated the costs/frequency of explanted instrumentation (devices implanted but removed prior to closure) for all single-level anterior diskectomy (1-ADF) procedures performed in 2010 at a single institution before and after surgeon education. OBJECTIVE: To determine whether surgeon education would reduce the costs/frequency of explantation for 1-ADF. SUMMARY OF BACKGROUND DATA: In 2009, we reported that the cost of explanted devices was 9.2% of the cost of implanted devices. METHODS: The costs/frequencies of explantation for 1-ADF performed in 2010 at the same institution by the same surgeons were analyzed before and after surgeon education. From January through April, surgeons were unaware of concerns regarding explantation. At the end of April 2010, spinal surgeons were educated about explantation costs/frequency at 2 meetings. Explantation costs/frequencies for the first 4 months of 2010 were compared with those for the last 8 months as well as with the results from 2009. RESULTS: Prior to surgeon education, instrumentation was explanted in 45.5% of the cases, whereas after education explantation occurred in 16% of the cases. The explantation rate (the number of explanted devices as a percentage of implanted devices) was lower after education for screws (12.5% vs. 7.7%), plates (9.4% vs. 0%), and allograft spacers (7.1% vs. 2.9%), and lower than for rates from 2009. In 2010, the overall cost of explanted devices as a percentage of implanted devices was also lower after surgeon education (5.8%) than before surgeon education in 2010 (20.0%) or 2009 (9.2%). CONCLUSION: The frequency and cost of explanted instrumentation used to perform 1-ADF were reduced through surgeon education.

Costs and frequency of "off-label" use of INFUSE for spinal fusions at one institution in 2010.

BACKGROUND: INFUSE, bone morphogenetic protein-2 combined with bovine Type I collagen in the lumbar tapered fusion device (LT Cage), is used to promote anterior lumbar interbody fusion (ALIF). In spinal surgery, INFUSE is only Federal Drug Administration (FDA) approved for this "on-label" use. While the efficacy and possible complications due to INFUSE have been debated, we know less about the costs and frequency of "on-label" versus "off-label" use of INFUSE to perform spinal fusions. METHODS: At one institution, we determined the costs (with overhead) and frequency of utilizing INFUSE "on-label" and "off-label" in performing spinal fusions during 2010. RESULTS: During 2010, 177 spinal fusions utilized INFUSE. Ninety-six percent, or 170 of 177 spinal fusions, utilized INFUSE in an "off-label" capacity at a cost of $4,547,822. Only 4%, or seven of 177 cases, utilized INFUSE in an "on-label" capacity (ALIF); the total cost was $296,419. CONCLUSIONS: In 2010, at one institution, 96% of the spinal fusions utilized INFUSE in an off-label capacity (cost $4,547,822), while only 4% were performed on-label (cost $296,4194).

The incidence and cost of devices explanted during single-level anterior diskectomy/fusions.

BACKGROUND: Little is known about the costs of devices explanted during anterior cervical diskectomy and fusion surgery. This retrospective study analyzes the costs to a single hospital of plates, screws and spacers used in all single-level anterior diskectomy and fusion (single-ADF) operations performed during a 1-year period. MATERIALS AND METHODS: Our objective was to determine the costs of instrumentation explanted (i.e. implanted during surgery but removed prior to closure) during 87 single-ADF procedures performed at a single institution within a single year, 2009. All 87 single-ADF procedures were analyzed to determine the frequency and costs (without overhead) to the hospital for both permanently implanted and explanted anterior cervical screws, plates, and spacers (allograft, artificial plastics, and cages). All patients undergoing single-ADF were included in this study irrespective of the diagnosis related group (DRG) category. RESULTS: THE COSTS, WITHOUT OVERHEAD TO THE HOSPITAL, FOR THE PERMANENTLY IMPLANTED INSTRUMENTATION WERE: screws ($103,572: 84 patients); plates ($120,694: 85 patients); allograft spacers ($92,776: 64 patients); cages ($38,821: 9 patients); and autografts (no charge; 14 patients), for a total of $355,863. The additional costs to the hospital for explanted instrumentation were: 37 screws ($11,014: 17 patients); 7 plates ($12,743: 5 patients); and 8 allograft spacers ($9093: 7 patients); there were no explanted cages. The total cost of the explanted devices was $32,850. CONCLUSIONS: During 87 single-ADF procedures, a total of 37 screws, 7 plates, and 8 spacers were explanted in 24 (27.6%) patients, resulting in an additional $32,850, 9.2%, to the cost of the implanted devices.