Comparison of value per operative time between anterior lumbar interbody fusion and lumbar disc arthroplasty: A propensity score-matched analysis

Abstract

Context: Despite the growing evidence demonstrating its effectiveness, lumbar disc arthroplasty (LDA) rates have not increased significantly in recent years. A likely contributing factor is uncertainties related to reimbursement and insurers' denial of coverage due to fear of late complications, reoperations, and unknown secondary costs. However, no prior study has compared the physician reimbursement rates of lumbar fusion and LDA. Aim: The aim of this study was to compare the relative value units (RVUs) per min as well as 30-day readmission, reoperation, and morbidity rates between anterior lumbar interbody fusion (ALIF) and LDA. Settings and Design: This was a retrospective cohort study. Subjects and Methods: The current study utilizes data obtained from the National Surgical Quality Improvement Program database. Patients who underwent ALIF or LDA between 2011 and 2019 were included in the study. Statistical Analysis Used: Propensity score matching analysis was performed according to demographic characteristics and comorbidities. Matched groups were compared through Fisher's exact test and independent t-test for categorical and continuous variables, respectively. Results: Five hundred and two patients who underwent ALIF were matched with 591 patients who underwent LDA. Mean RVUs per min was significantly higher for ALIF compared to LDA. ALIF was associated with a significantly higher 30-day morbidity rate compared to LDA, while readmission and reoperation rates were statistically similar. ALIF was also associated with higher frequencies of deep venous thrombosis (DVT) and blood transfusions. Conclusions: ALIF is associated with significantly higher RVUs per min compared to LDA. ALIF is also associated with higher rates of 30-day morbidity, DVT, and blood transfusions, while readmission and reoperation rates were statistically similar.