1204 TLIF Costs are Significantly Driven by Surgical Location, Technique, and Length of Stay

INTRODUCTION: TLIFs are among the most common spine fusions and thus present significant economic implications for payers and providers. Prior TLIF cost studies have shown mixed results across technique and location, often employing suboptimal methodologies such as Medicare-based reimbursement, exclusion of implant costs, or poorly defined practice settings. METHODS: This retrospective, single-center cohort study compared primary, single-level TLIFs at a single tertiary-care hospital. Open TLIF procedures were performed either outpatient (23-hour observation) or inpatient (=2 midnights) at the main hospital. A single-surgeon sample of minimally invasive TLIFs (miTLIFs) was performed with same-day discharge from an ambulatory surgery center. Total costs included surgeon fees, anesthesia costs, implant expenses, and hospital-associated costs. RESULTS: A total of 174 participants met inclusion criteria and underwent open TLIF (92 inpatient, 59 outpatient) or ambulatory miTLIF (23). There were no significant differences in postoperative disc height or pain scores at 3 months between the open TLIF and miTLIF cohorts. Median total costs for inpatient open TLIF were $42,855 (Q1:$34,412, Q3:$48,999) compared to outpatient open TLIF costs of $35,424 (Q1:$32,394, Q3:$41,324) and ambulatory miTLIF costs of $33,367 (Q1:$30,615, Q3:$34,983). Analysis revealed outpatient TLIF can be performed as efficiently as ambulatory miTLIF from a variable cost perspective. However, ambulatory miTLIF incurred significantly lower fixed costs than open TLIF (p<0.001). CONCLUSIONS: TLIF costs are significantly impacted by location, surgeon expertise, technique, and length of stay. An experienced miTLIF surgeon in an ambulatory surgery center can achieve the lowest overall costs by avoiding high fixed and overnight hospital costs. However, an experienced hospital-based open TLIF surgeon can match ambulatory miTLIF variable costs with efficient outpatient surgery.