{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T20:29:00Z","timestamp":1792441740521,"version":"4.5.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Measuring costs across entire episodes of care, time-driven activity-based costing (TDABC) has recently been described as a novel cost accounting arm of value-based care organizations. Lean methodology is a system used to understand pathways of care at a granular level, allowing for standardization. The current work presents an attempt at combining the 2 methodologies to detect meaningful variation in a patient\u2019s care following single-level spine fusion. The objective of this study was to evaluate the combination of TDABC and lean methodologies in detecting meaningful variability in time-based care in patients undergoing single-level spine fusion surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>This study is a consecutive case series of patients who underwent single-level spine fusion performed by 1 of 5 fellowship-trained spine surgeons. Patients were diagnosed with either lumbar stenosis or spondylolisthesis. Additional inclusion criteria included inpatient stays from 1 to 3 days, discharge to home, and no readmission within 30 days of surgery. Patient demographic data were obtained. Time spent on activities for each personnel role was aggregated in 15-minute increments occurring preoperatively, intraoperatively, and postoperatively. Patients were analyzed in 3 groups based on the duration of their in-hospital stay.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Patients discharged on postoperative day (POD) 3 had statistically significantly more total time spent than those discharged on POD 2. Patients discharged on POD 1 had less total time than those in the former 2 groups. The amount of time spent with patients did not differ for personnel in either preoperative or postanesthesia care unit phases of care. There was a statistically significant difference in time spent in surgery for surgeons, anesthesia attendings, circulators, and scrub technicians.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In a healthcare setting run by lean methodology, TDABC may detect meaningful variability in an episode of care for single-level spine fusion. Clinicians and administrators can use this combination to allocate costs appropriately, optimize value care streams, and help improve patient care.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2022.4.spine211516","type":"journal-article","created":{"date-parts":[[2022,6,24]],"date-time":"2022-06-24T08:29:34Z","timestamp":1656059374000},"page":"639-645","source":"Crossref","is-referenced-by-count":7,"title":["Combining time-driven activity-based costing and lean methodology: an initial study of single-level lumbar fusion surgery to assess value-based healthcare in patients undergoing spine surgery"],"prefix":"10.3171","volume":"37","author":[{"given":"Rajiv K.","family":"Sethi","sequence":"first","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"},{"name":"Department of Health Systems and Population Health, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline E.","family":"Drolet","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca P.","family":"Pumpian","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Shen","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelsey","family":"Hanson","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Guerra","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip K.","family":"Louie","sequence":"additional","affiliation":[{"name":"Center for Neurosciences and Spine, Virginia Mason Franciscan Health, Seattle; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.1016\/j.spinee.2021.04.006","article-title":"Value-based health care in spine: where do we go from here?","volume":"21","author":"Karhade AV","year":"2021","unstructured":"Karhade AV, Bono CM, Makhni MC,  Value-based health care in spine: where do we go from here?. 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