Does body mass index influence intraoperative costs and operative times for open transforaminal lumbar interbody fusion? A time-driven activity-based costing analysis

• DOI: 10.1016/j.xnsj.2025.100583
• Publication Date: 2025-01-18T19:32:30Z
• Authors: Danyal A. Quraishi; Advith Sarikonda; D. Mitchell Self; Emily L. Isch; Steven Glener; Arbaz Momin; Ashmal Sami; Nicholas Clark; Joshua Heller; Srinivas K. Prasad; Ashwini Sharan; Jack Jallo; James Harrop; Alexander R. Vaccaro; Ahilan Sivaganesan
• Keywords: obesity; Time-driven activity-based costing; 610; body mass index; Transforaminal lumbar interbody fusion; operative times; healthcare costs; transforaminal lumbar interbody fusion; Medicine and Health Sciences; 617; health economics; Spinal fusion surgery; intraoperative costs; spinal fusion surgery; RC346-429; Body mass index; Operative times; Orthopedic surgery; operating room efficiency; Surgical Procedures; Neurosciences; Operative; time-driven activity-based costing; bundled payments; Intraoperative costs; Neurology. Diseases of the nervous system; RD701-811

The increasing prevalence of obesity has raised concerns about its impact on surgical outcomes and healthcare costs. This study evaluates the influence Body Mass Index (BMI) intraoperative costs operative times during open Transforaminal Lumbar Interbody Fusion (TLIF) procedures using a Time-Driven Activity-Based Costing (TDABC) approach. A retrospective analysis was conducted 279 patients who underwent TLIF between 2019 2022. Patients were categorized into 5 BMI cohorts: healthy weight (BMI 18.5-24.99), overweight 25.0-29.99), Class I obese 30.0-34.99), II 35.0-39.99), III >40). Intraoperative calculated TDABC methodology, with segmented supply personnel expenses. Operative measured in 3 phases: surgery time (incision to closure), OR (patient entering leaving), turnover time. Multivariable regression models assessed relationship various cost metrics, adjusting for potential confounders. significantly associated increased Each unit increase corresponded an additional 1.90 minutes operating room (p = .01) $25.72 .008). However, no significant association found total or Regression analyses indicated that did not differ from terms Higher is procedures, though it does when controlling These findings suggest may need be deterrent patient selection under bundled payment models.