324 How Much Money Do You Actually Save Your Hospital When You Choose a Posterior Foraminotomy Instead of an ACDF for Cervical Radiculopathy?

Abstract

INTRODUCTION: To our knowledge, a comparison of the true intraoperative costs of anterior cervical fusion (ACDF) vs. posterior cervical foraminotomy (PCF) has never been done. METHODS: Total cost was divided into direct and indirect costs. Individual costs were obtained by direct observation, electronic medical records, and through querying multiple departments. Timestamps for personnel and material resources were documented. Total intraoperative costs were estimated for all single-level ACDFs and PCFs from 2017 to 2022. Regression analyses were performed to identify factors associated with total cost. RESULTS: A total of 256 and 32 patients underwent single-level ACDFs and PCF for cervical radiculopathy, respectively. The average total intraoperative cost for ACDFs was $7,574 ± $3,175 versus $3,062 ± $547 for PCF. For ACDFs, supply cost (69% for ACDFs vs. 33% for PCF) was the major contributor, while personnel cost (67% for PCF vs. 31% for ACDFs) constituted most of the cost incurred during PCFs. Supply cost, particularly implant cost ($3,818 ± $2,316), appeared to influence cost variability in ACDFs, while personnel cost ($2,051 ± $419) seemingly explained cost variability in PCFs. On linear regression analysis, ACDFs (β coefficient: $4,685 ± $575, p < 0.001), males (p = 0.03), and patients with commercial insurance (p = 0.01) had significantly higher total costs when controlled for age, comorbidities, and smoking status. CONCLUSIONS: TDABC is a feasible methodology for estimating differences in true intraoperative costs between ACDFs and PCFs for cervical radiculopathy. The major cost contributors were supply and personnel costs. Implant cost appeared to influence total cost variability in ACDFs, while personnel costs seemingly explained cost variability among PCFs. ACDFs were associated with an additional $4,685 ± $575 of total intraoperative cost as compared to PCFs. Males and patients with commercial insurance were also associated with significantly higher total costs.