Defining the Value of Elective Lumbar Fusion: A Systematic Review of Existing Methodologies and Framework for the Operative Value Index

Authors

• Advith Sarikonda, Thomas Jefferson UniversityFollow
• Anthony Chen, Thomas Jefferson UniversityFollow
• Theo S. Biddle, Thomas Jefferson UniversityFollow
• Danyal A. Quraishi
• Preston Carey, Thomas Jefferson UniversityFollow
• Arbaz A. Momin, Thomas Jefferson UniversityFollow
• Matthews Lan, Thomas Jefferson UniversityFollow
• Dwight Mitchell Self, Thomas Jefferson UniversityFollow
• Ashmal S. Kabani, Thomas Jefferson UniversityFollow
• Ahilan Sivaganesan, Thomas Jefferson University

Document Type

Article

Publication Date

8-1-2026

Comments

This article is the author's final published version in Journal of Neurosurgical Sciences, Volume 70, Issue 4, August 2026, Pages 318-331.

The published version is available at https://doi.org/10.23736/S0390-5616.26.06769-X. Copyright © 2026 THE AUTHORS.

Abstract

BACKGROUND: Despite wide variation in the outcomes and costs of lumbar fusion, few studies have integrated these domains together within a single metric to assess "value" (outcomes achieved per dollar spent). In this review, we sought to 1) characterize existing metrics of cost-effectiveness for lumbar fusion, 2) evaluate all applications of time-driven activity-based costing (TDABC) in spine surgery, and 3) outline the conceptual foundation for a standardized Operative Value Index (OVI).

METHODS: Two PRISMA-concordant systematic reviews were performed on PubMed and Scopus databases. The first review examined all studies which reported a cost-effectiveness metric for lumbar fusion. The second review examined all applications of TDBAC in spine surgery.

RESULTS: Among 366 screened studies, 40 (21 for cost-effectiveness in lumbar fusion, 19 for TDABC in spine surgery) fulfilled inclusion criteria. The incremental cost-effectiveness ratio (ICER) was the most common metric, followed by OVI. Costs were frequently defined as reimbursement or charges; few studies assessed actual costs or TDABC. TDABC studies consistently demonstrated that costs were driven primarily by surgeon-level and procedure-specific factors, not patient characteristics. OVI studies uniformly used TDABC costs combined with disease-specific outcomes, but were limited to short-term follow-up and primarily intraoperative costs.

CONCLUSIONS: Current value assessments in lumbar fusion are limited by heterogeneous outcomes and imprecise costing. A standardized framework integrating pathology-specific outcomes with episode-level costing (not charges or reimbursement) may enable more generalizable and accurate comparisons of operative value.

Recommended Citation

Sarikonda, Advith; Chen, Anthony; Biddle, Theo S.; Quraishi, Danyal A.; Carey, Preston; Momin, Arbaz A.; Lan, Matthews; Self, Dwight Mitchell; Kabani, Ashmal S.; and Sivaganesan, Ahilan, "Defining the Value of Elective Lumbar Fusion: A Systematic Review of Existing Methodologies and Framework for the Operative Value Index" (2026). Department of Neurosurgery Faculty Papers. Paper 308.
https://jdc.jefferson.edu/neurosurgeryfp/308

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

PubMed ID

41883320

Language

English