The incidence and cost of devices explanted during single-level anterior diskectomy/fusions

BACKGROUND: Little is known about the costs of devices explanted during anterior cervical diskectomy and fusion surgery. This retrospective study analyzes the costs to a single hospital of plates, screws and spacers used in all single-level anterior diskectomy and fusion (single-ADF) operations performed during a 1-year period. MATERIALS AND METHODS: Our objective was to determine the costs of instrumentation explanted (i.e. implanted during surgery but removed prior to closure) during 87 single-ADF procedures performed at a single institution within a single year, 2009. All 87 single-ADF procedures were analyzed to determine the frequency and costs (without overhead) to the hospital for both permanently implanted and explanted anterior cervical screws, plates, and spacers (allograft, artificial plastics, and cages). All patients undergoing single-ADF were included in this study irrespective of the diagnosis related group (DRG) category. RESULTS: The costs, without overhead to the hospital, for the permanently implanted instrumentation were: screws ($103,572: 84 patients); plates ($120,694: 85 patients); allograft spacers ($92,776: 64 patients); cages ($38,821: 9 patients); and autografts (no charge; 14 patients), for a total of $355,863. The additional costs to the hospital for explanted instrumentation were: 37 screws ($11,014: 17 patients); 7 plates ($12,743: 5 patients); and 8 allograft spacers ($9093: 7 patients); there were no explanted cages. The total cost of the explanted devices was $32,850. CONCLUSIONS: During 87 single-ADF procedures, a total of 37 screws, 7 plates, and 8 spacers were explanted in 24 (27.6%) patients, resulting in an additional $32,850, 9.2%, to the cost of the implanted devices.