Is Endoscopic Thoracic Discectomy More Cost Effective Than the Standard, Open Approach?

Friday, May 3, 2024

1:45 PM – 1:49 PM CT

Location: S401ab

Presenting Author(s)

David Liles, MD

Resident
Vanderbilt University Medical Center
Nashville, TN, US

Co-Author(s)

AA

Amir Abtahi, MD

orthopedic surgeon
Department of Orthopedic Surgery, Vanderbilt University Medi, United States
Hani Chanbour, MD

Spine Fellow
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
Nashville, TN, US
Robert J. Dambrino, IV, MD, MPH

Resident Physician
Vanderbilt University Medical Center, Department of Neurological Surgery
Nashville, Tennessee, United States
Raymond Gardocki, MD

Orthopedic Surgeon
Department of Orthopedic Surgery, Vanderbilt University Medi
Franklin, Tennessee, United States
SJ

Soren Jonzzon, MD

Resident
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
Nashville, Tennessee, United States
KP

Keyan Peterson, MD

Resident
Vanderbilt University medical center, United States
BS

Byron Stephens, MD

Orthopedic Surgeon
Vanderbilt University School of Medicine, United States
Iyan Younus, MD

Resident
Vanderbilt University Medical Center
Nashville, Tennessee, United States
Scott L. Zuckerman, MD, MPH (he/him/his)

Assistant Professor of Neurological Surgery
Vanderbilt University Medical Center
Nashville, Tennessee, United States

Disclosure(s):

Campbell Liles, MD: No financial relationships to disclose

Hani Chanbour, MD: No financial relationships to disclose

Introduction: Open thoracic discectomy often requires transpedicular decompression and fusion with extensive hospital stays. The advent of endoscopic thoracic discectomy offers a less invasive alternative, however, comparative costs, resource utilization, and outcomes for endoscopic versus open thoracic discectomy is unknown. In a cohort of patients undergoing one-level thoracic discectomy, we sought to compare the open vs. endoscopic approach regarding: 1) perioperative and postoperative outcomes, and 2) total cost.

Methods: A single-center, retrospective, cohort study using prospectively collected data of patients undergoing one-level thoracic discectomy was undertaken between 2018-2023. The primary exposure variable was open vs. endoscopic approach. The primary outcome was perioperative and postoperative outcomes. Secondary outcomes included Initial surgical cost was defined as the total cost-of-care for the initial surgery and hospital stay.

Results: 17 open and 12 endoscopic thoracic surgeries were performed for symptomatic thoracic discs. Preoperative demographics, symptoms, and radiographic findings were comparable between the cohorts. Open surgery had significantly higher length-of-stay [Mean±95%CI (days)] (4.9±1.5 vs. 0, p< 0.001), longer operative time (p < 0.001), and more blood loss (p < 0.001). 16 (94%) open patients required fusion versus 0 endoscopic (p < 0.001). 6-week rates of neurological improvement (p>0.999), readmissions (p=0.665), and reoperations (p=0.553) were not significantly different. While a higher rate of postoperative opioid was found in the open approach, this did not reach statistical significance (76.5% vs. 41.7%,p=0.119). Open surgical costs were 7x higher ($59,792, IQR $16,118) vs. endoscopic [$8,128, IQR $1,848);p < 0.001] driven by length-of-stay (β=$2,288/night, p< 0.001), operative time (β=$60/minute,p < 0.001), open surgery (β=$18,692,p < 0.001) and number of screws (β=$981/screw, p=0.066) on multivariable analysis. On sensitivity analysis, open repair was never cost-efficient against endoscopic repair and endoscopic revision rates of 86% were required for break-even cost.

Conclusion : Endoscopic thoracic discectomy was associated with significantly decreased costs compared to open surgery, with significantly decreased LOS, operative time, and blood loss, and along with similar neurological outcomes, readmissions, and reoperations. These findings may help patients and surgeons seek endoscopic thoracic discectomy as a less morbid surgical alternative when appropriate.