August 2012 Dear Colleague: There’s good news about minimally invasive lumbar fusions―both na onally and locally―to reduce pa ents’ pain, disability, and length of hospitalization. I wanted to pass it along because of the growing emphasis on containing health-care costs, and because of the increasingly collaborative nature of medical practice in this era of Patient Centered Medical Homes and Accountable Care Organizations. National Multi-Institutional Study Previously, there had been little data demonstrating the cost-effectiveness of these procedures in treating degenerative lumbar disease relative to open lumbar fusions. But recently, neurosurgeon Michael Y. Wang and colleagues at the University of Miami published the results of a retrospective database review that 1 addressed this issue authoritatively. His study, which analyzed the inpatient records of 6,106 patients between 2002 and 2009, determined that hospital stays for 1-level minimally invasive inter-body fusions averaged 3.35 days versus 3.6 days for open surgery, so the cost difference there was insignificant. However, for 2-level inter-body fusions, the minimally invasive LOS was 3.4 days versus 4.03 days for open surgery―or a mean cost savings of $2,105 per case. The savings were mainly attributable to lower costs for room and board ($857), operating room ($359), pharmacy ($304), and lab work ($166) due to earlier discharge. MNI Study at Genesys Regional Medical Center Among the clinical studies we’ve conducted at Michigan Neurosurgical Institute was a comparison of outcomes of minimally invasive transfacet lumbar fusion at single and multiple levels. Our study included 57 cases I performed between May 2005 and June 2011 (42 single-level , 15 multi-level ). Mean LOS was similar for both groups (single-level fusions, 1.8 days; multi-level, 1.35 days)―far shorter and far less costly than the national average costs for either minimally invasive or open lumbar fusions. Patients were followed for 12 months post-operatively. Their analgesic requirements decreased significantly over that period. Clinical outcomes were measured using the Visual Analog Scale, Oswestry Disability Index, and RAND Short Form Survey -36 (SF-36). Seven developed post-op complications (6 required repositioning of a screw, 1 required revision of the inter-body cage.) Conclusion: minimally invasive transfacet inter-body fusion is a safe and effective treatment for lumbar instability and degenerative disc diseases.
1 “Acute Hospital Costs After Minimally Invasive Versus Open Lumbar Interbody Fusion: Data From a US National Database With 6106 Patients,” Wang, Michael Y. MD, FACS; Lerner, Jason PT, MBA; Lesko, James PhD; McGirt, Matthew J. MD; Journal of Spinal Disorders & Techniques; June 16, 2011.
Our Outcome Reports on Your Referrals Finally, you may also be interested to know that our outcome reports on patients you refer to us are based on the SF-36 survey. Part of RAND’s multi-year, multi-site Medical Outcomes Study, it is “a set of generic, coherent, and easily administered quality-of-life measures that rely upon patient self-reporting and are widely used by managed care organizations and by Medicare for routine monitoring and assessment of care outcomes in adult patients.” MNI staff members record the data provided by your patients in a computer program containing an unbiased, standard SF-36 calculation algorithm, and it determines each individual’s scores on a variety of measures (Physical Function, Role-Physical, Body Pain, General Health, Vitality, Social, Role-Emotional, Mental Health, Health Transition, Phys Comp Summary, Mental Comp Summary, and Total.) Kimberly Barber, Ph.D., in the Office of Research at Genesys Regional Medical Center can provide further insights on the SF-36, as well as on the great variety of clinical research being conducted here. Please don’t hesitate to contact me personally if you have questions about our outcome reports, or any aspect of the care we provide for your patients. We strive to achieve an optimal outcome for each and every patient you entrust to our care. Sincerely,
Avery M. Jackson III, M.D., F.A.C.S., F.A.A.N.S. Michigan Neurosurgical Institute, P.C. Diplomate of the American Board of Neurological Surgery