Costs of Full Endoscopic Spine Surgery: a Narrative Review

Abstract

PURPOSE The purpose of this narrative review was to summarize the current literature reporting costs of full endoscopic spine surgery (FESS). METHODS Studies assessing costs in FESS written in English were included. PubMed and Embase databases were screened by the authors. Data regarding costs were extracted and reported in the current review. RESULTS Nine studies were included. Seven studies were retrospective comparative and 2 were randomized-controlled-trials. The studies included treatment of lumbar disc herniation (LDH), lumbar spinal stenosis (LSS) and cervical disc herniation (CDH). Eight studies reported a comparison of FESS to open microscopic surgery. Four of them reported lower total costs in FESS. The methodologies used for cost analysis exhibited heterogeneity in terms of both the data source and accounting methodology. Length of hospital stay (LOS) and type of anesthesia consistently affected total costs. CONCLUSION Included studies report inconsistent results regarding total costs of FESS compared to open microscopic surgery. LOS and type of anesthesia seems to be the two main costs drivers. As endoscopic surgery continues to gain popularity, further research is needed to evaluate the long-term cost-effectiveness and impact on patient outcomes, however a standardization of methodology of costs-analysis is warranted.