Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion.

Abstract

This was a retrospective cohort study. The aim of this study was to compare the hospital charges and postoperative complications of minimally invasive surgery (MIS) and open approaches to sacroiliac joint (SIJ) fusion. The data source utilized in this study is the Healthcare Cost and Utilization Project National Readmission Database (NRD) from 2016 and 2017. The NRD is a yearly nationally representative inpatient database from the Agency for Healthcare Research and Quality with information regarding patient demographics, diagnoses, procedures, and readmissions. The 2016-2017 NRD was used to identify 2521 patients receiving SIJ fusion with open (n=1990) or MIS approaches (n=531) for diagnosed sacrum pain, sacroiliitis, sacral instability, or spondylosis after excluding for those who received prior SIJ fusion, those diagnosed with neoplasms or trauma of the pelvis or sacrum, and nonelective procedures. We then one-to-one propensity-matched the open (n=531) to the MIS approach (n=531) for age, sex, and Charlson Comorbidity Index. Statistical analysis was performed to compare total hospital charges, immediate surgical complications, nonelective readmission rate, and 30-, 90-, and 180-day postoperative complications between the 2 approaches. The mean total hospital charge was the only significant difference between 2 group. Open SIJ fusion had significantly higher charge compared with the MIS approach (open $101,061.90±$81,136.67; MIS $83,594.78±$49,086.00, P<0.0001). The open approach was associated with nonsignificant higher rates of novel lumbar pathology at 30-, 90-, and 180-day readmissions and revision surgeries at 30 and 180 days. MIS approach had higher rates nervous system complications at 30-, 90-, and 180-day readmission, as well as infection and urinary tract infection within 30 days, none being significant. Novel postprocedural pain was similar between the 2 groups at 90 and 180 days. The current study found that open SIJ fusion was associated with significantly higher hospital charges. Although no significant differences in postoperative complications were found, there were several notable trends specific to each surgical approach.