Cost–utility of minimally invasive versus open transforaminal lumbar interbody fusion: systematic review and economic evaluation

摘要

PurposeTo assess the cost–utility and perioperative costs of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) versus open-TLIF for degenerative lumbar pathologies.MethodsRelevant articles were identified from six electronic databases. Predefined end points were extracted and meta-analysis conducted from the identified studies.ResultsFor each study, the direct hospital cost for MI-TLIF was found to be less than that of open-TLIF. When these outcomes were pooled, direct hospital costs were found to be significantly lower in the MI-TLIF group [weighted mean difference (WMD), ?$2820; I 2?=?61?%; P??0.00001]. MI-TLIF was also associated with shorter hospitalization (WMD, 0.99; 95?% CI ?1.81, ?0.17; I 2?=?96?%; P?=?0.02), trend toward reduced complications (relative risk 0.53; 95?% CI 0.23, 1.06; I 2?=?0?%; P?=?0.07), and reduced blood loss (WMD, ?246.40?mL; I 2?=?98?%; P?=?0.003), but was not associated with a significant difference in operation time (WMD, ?67.05; 95?% CI ?169.44, 35.35; I 2?=?100?%; P?=?0.20).ConclusionsFrom the limited evidence, the available data suggest a trend of significantly reduced perioperative costs, length of stay, and blood loss for minimally invasive compared with open surgical approaches for TLIF. MI-TLIF may represent an opportunity for optimal utilization and allocation of health-care resources from both a hospital and societal perspective...