1030 How Do the True Intraoperative Costs of Endoscopic Discectomy Compare to Microdiscectomy for Lumbar Disc Herniations? A Time-Driven Activity-Based Cost Analysis

INTRODUCTION: Endoscopic lumbar discectomy (ED) is a minimally invasive option for addressing lumbar disc herniations. With the introduction of value-based care systems, assessing the true cost of certain procedures is critical when creating reimbursement models and comparing procedures. METHODS: Total cost for the intraoperative episode was calculated using TDABC methodology. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Timestamps for all involved personnel and material resources were documented. A retrospective analysis was performed on 202 patients who underwent lumbar discectomy through either MD (n=167) or ED (n=35) from 2018-2022. Personnel cost was calculated by multiplying the cost-per unit time for each personnel type by the length of time spent in the operating room. Supply cost was calculated by aggregating the cost of all individual supplies, from medications to consumables to surgical trays, utilized during the case. Univariate and multivariable regression analyses were performed comparing the costs between these procedures. RESULTS: The average intraoperative cost per case for ED and MD was $3915 +/- $1025 and $3162 +/- $954, respectively. Multivariable regression analysis revealed that ED had higher total cost (β-coefficient: $912 +/- $281, p=<0.01) and supply cost (β-coefficient: $474 +/- $155, p=<0.01) than MD. When accounting for surgeon as a covariate, however, total cost (p=0.478) and supply cost (p=0.468) differences between ED and MD were negligible. CONCLUSIONS: ED has shown to be a better value option in addressing lumbar disc herniations, mostly due to advantages in perioperative care. Here, we show that when correcting for surgeon-level effects, the cost between the two procedures is statistically insignificant, reaffirming the value provided by ED.