1032 Can We Finally Quantify Value for Lumbar Fusions? Introducing the Operative Value Index (OVI)

INTRODUCTION: Patient-reported outcomes (PRO) and cost analyses have become mainstays of clinical research for spine surgery in recent years. To our knowledge, however, no attempt has been made to merge PROs with time-driven activity-based costing (TDABC) to quantify value at the surgeon- and procedure-level. Here, we aim to bridge this gap. METHODS: This is a retrospective analysis of 143 consecutive single-level transforaminal lumbar interbody fusions (TLIFs) at a large academic center. Intraoperative TDABC was employed to estimate both direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments (business operations, sterile processing, plant operations, and pharmacy). Oswestry Disability Index (ODI) scores were collected at baseline and 3-months after surgery. The Operative Value Index (OVI) was defined as the percent improvement in ODI per $1,000 spent intraoperatively .We also divided the total intra-operative cost by the absolute ODI point-change for each case to calculate a Unit Price for Outcomes (UPO). Generalized linear mixed models (GLMM) were built to assess surgeon-level variability in OVI. Three distinct surgeon cohorts were created: Surgeon A (n=75 cases), Surgeon B (n=39 cases), and “Other Surgeons” (n=7 surgeons, 28 cases). RESULTS: 143 single-level TLIFs were performed by 9 surgeons from 2017 to 2022. The average total cost of a one-level TLIF was $11,984 +/- $3,312. The average OVI and UPO for all cases was 3.2 +/- 4.3 and $643 +/- $3,929, respectively. On GLMM, “Other Surgeons” were associated with significantly decreased OVI (p<0.05) compared to Surgeon A, though there was no significant difference in OVI between Surgeon A and Surgeon B (p=0.56). CONCLUSIONS: We present novel metrics that quantify value for single-level TLIF by combining a diagnosis-specific PRO with TDABC. Metrics such as these can help stakeholders identify drivers of variation in the value provided by spine surgeons.