{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T13:51:35Z","timestamp":1778939495442,"version":"3.51.4"},"reference-count":35,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2011,6]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior\/transforaminal lumbar interbody fusion (P\/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P\/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P\/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P\/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P\/TLIF as reported in a large administrative database.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P\/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P\/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Five thousand one hundred seventy patients undergoing P\/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P\/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P\/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P\/TLIF, the incidence of SSI (27 [4.6%] vs 150 [7.0%], p = 0.037) and mean SSI-associated cost per P\/TLIF ($756 vs $1140, p = 0.030) were both significantly lower among MI-treated patients. In a multivariate model that accounted for differences in demographics and patient severity, open fusion was associated with a strong trend of increased incidence of SSI as compared with MI fusion (OR 1.469, 95% CI 0.959\u20132.250).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P\/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P\/TLIF.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.1.spine10571","type":"journal-article","created":{"date-parts":[[2011,3,18]],"date-time":"2011-03-18T14:22:09Z","timestamp":1300458129000},"page":"771-778","source":"Crossref","is-referenced-by-count":138,"title":["Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior\/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients"],"prefix":"10.3171","volume":"14","author":[{"given":"Matthew J.","family":"McGirt","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott L.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Lerner","sequence":"additional","affiliation":[{"name":"DePuy Spine, Inc., Raynham, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luella","family":"Engelhart","sequence":"additional","affiliation":[{"name":"DePuy Spine, Inc., Raynham, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler","family":"Knight","sequence":"additional","affiliation":[{"name":"Covance Market Access Services, Inc., Gaithersburg, Maryland; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine10571","series-title":"Am J Orthop","first-page":"E115","article-title":"Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up","volume":"38","author":"Arnold","year":"2009"},{"key":"b2-spine10571","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1097\/00006123-200208000-00017","article-title":"Efficacy of prophylactic antibiotic therapy in spinal surgery: a meta-analysis","volume":"51","author":"Barker","year":"2002"},{"issue":"3","key":"b3-spine10571","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Postoperative wound infections of the spine","volume":"15","author":"Beiner","year":"2003"},{"key":"b4-spine10571","series-title":"Support Care Cancer","first-page":"131","article-title":"Resource utilization and costs associated with chemotherapy-induced nausea and vomiting (CINV) following highly or moderately emetogenic chemotherapy administered in the US outpatient hospital setting","volume":"19","author":"Burke","year":"2010"},{"key":"b5-spine10571","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/S0030-5898(20)32060-5","article-title":"Cost of medical care for postoperative spinal infections","volume":"27","author":"Calderone","year":"1996"},{"key":"b6-spine10571","series-title":"Orthop Clin North Am","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S0030-5898(20)32062-9","article-title":"Outcome assessment in spinal infections","volume":"27","author":"Calderone","year":"1996"},{"key":"b7-spine10571","series-title":"J Chronic Dis","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b8-spine10571","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3171\/SPI.2008.9.08142","article-title":"Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up","volume":"9","author":"Dhall","year":"2008"},{"key":"b9-spine10571","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.2106\/00004623-200706000-00001","article-title":"Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. 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