Cost Difference Between Open Surgery and Minimally Invasive Surgery for the Treatment of Traumatic Thoracolumbar Fractures.

Abstract

Spinal vertebral fractures pose a significant healthcare burden due to their frequency and impact on quality of life, resulting in substantial social costs. Minimally invasive surgery (MIS) offers advantages over traditional open surgery (OS), such as reduced tissue damage, less postoperative pain, and shorter hospital stays, although it involves higher implant costs. Research comparing the overall direct costs of these interventions is limited. This study aims to compare the direct hospital-care costs associated with OS and MIS for thoracolumbar vertebral fractures in Spain. We conducted an ambispective analysis of patients treated for thoracolumbar unstable fractures at our hospital from January 2004 to July 2022. Patients were categorized into OS and MIS groups. We performed analyses on the entire cohort, patients with minor trauma, and applied propensity score matching. Direct hospital costs were documented and adjusted for inflation. Out of 218 patients, 75 underwent OS and 143 received MIS. Cost analysis indicated that MIS patients had shorter hospital stays and lower admission costs, though total costs did not differ significantly. Multivariate analysis showed OS was slightly more expensive but not significantly so. Propensity score matching confirmed similar findings. For patients with minor trauma, MIS again showed shorter stays and lower costs, with no significant difference in total costs. All cohorts exhibited significantly lower blood expenditure with MIS. The study demonstrates that MIS is not inferior to OS in terms of costs, with some advantages like reduced blood bank expenses. Further high-quality randomized controlled trials with economic evaluations are needed for more definitive conclusions.