Incidental Durotomies Increase Healthcare-Associated Cost in Spine Surgery: A Systematic Review and Meta-Analysis

Study Design: Systematic review and meta-analysis. Objective: Incidental durotomies (ID) are common complications in spine surgery. The primary objective of this study was to pool and analyze the cost estimates incurred after ID in the available literature. The secondary objective was to investigate the effects of ID on likely cost drivers, including readmission rates, complications, operative time, and length of stay. Methods: Three databases, PubMed, EMBASE, and Google Scholar, were searched from inception through February 2022 for articles reporting costs associated with ID. Information on study design, demographic data, durotomy rates, and costs was extracted. The estimates were combined using random-effects models. Additional subgroup and sensitivity analyses were conducted according to a predefined protocol. Results: The initial search of all databases identified 1263 articles after duplicates were removed. The final analysis was conducted on 7 articles reporting on 17,458 ID patients and 202,960 controls. These articles evaluated the additional cost of an ID in a wide variety of spine surgical procedures. All studies, except one, were retrospective in nature and originated in the United States. IDs were significantly associated with increased cost in most studies, despite substantial heterogeneity, with estimates ranging from approximately $1,200–$16,400 USD. Overall, the major cost driver identified was increased length of stay. Secondary complications related to durotomy were not observed as a driver of cost. Conclusion: This systematic review and meta-analysis demonstrate that hospitalization costs are higher in patients suffering from IDs after spine surgery than in those without IDs. The primary cost driver in this patient population is increased length of stay.