90. Cost-benefit analysis of multimodal intraoperative monitoring during spine surgery

Abstract

Multimodal intraoperative neurophysiological monitoring (IOM) during spine surgery was introduced in clinical practice to reduce the risk of permanent neurological deficit post-surgery. The early detection of changes in neurophysiological parameters during surgical procedure, makes it possible to reverse the damage before it becomes permanent. The economic impact of the IOM, a rather difficult topic, was estimated with sufficient accuracy. We have done a review of the costs, in our department, ranging into a minimum of 220 euro for the peripheral nervous system and a maximum of 630 euro for spine surgery. Even if the rate of complications during IOM remains very low (about 1%), the costs of performing IOM surely do not exceed those of health care for the injured patients, so that the economic burden of neurological damage justifies widely the cost of the procedure. Moreover, indirect costs are often underestimated: loss of job, career setbacks of the patient or a family member close to him. One aspect that can not be measured is the impact of a possible psychological and social permanent deficit, especially when the affection of a specific function limits the chances of social relationship.