Cost implications of prolonged lumbar spine surgery at National Orthopaedic Hospital Dala Kano, Nigeria

Vollständiger Abstract

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Background: Prolonged operative time is associated with increased morbidity and resource utilization in spine surgery. However, the cost implications of prolonged lumbar spine surgery in low‑resource Nigerian settings have not been quantified. This study compared direct costs between patients with operative time ≤2 hours and those >2 hours for lumbar decompression and stabilisation. Methods: A retrospective cohort study of 82 consecutive patients who underwent elective L2-L5 decompression and pedicle screw stabilisation at National Orthopaedic Hospital Dala, Kano, between January 2023 and December 2025 was conducted. Patients were divided into two groups: Group A (operative time ≤120 minutes, n=35) and group B (operative time >120 minutes, n=47). Direct costs (personnel, consumables, implants, operating theatre time, anaesthesia, postoperative care) were calculated from hospital billing records. Outcomes included total cost, length of stay, and complication rates. Results: The mean operative time was 98±15 minutes in Group A and 175±28 minutes in Group B (p<0.001). Total direct cost per patient was significantly higher in Group B: ₦ 1,245,000 (US$ 2,718) vs ₦ 875,000 (US$ 1,910) in Group A (p<0.001). The excess cost attributable to prolonged surgery was ₦370,000 (US$808) per patient. Prolonged surgery was associated with longer hospital stay (8.4±2.2 vs 5.6±1.5 days, p<0.001) and higher complication rates (23.4% vs 8.6%, p=0.04). Multivariate analysis identified operative time >2 hours as an independent predictor of increased total cost (β=0.52, p<0.001) after adjusting for age and comorbidity. Conclusions: Prolonged lumbar spine surgery (>2 hours) is associated with significantly higher direct costs, longer hospital stay, and increased complications. Strategies to reduce operative time-including surgeon training, team optimisation, and implant standardisation-could generate substantial cost savings in resource‑limited settings.