article · International Journal of Advances in Medicine
A retrospective study of 82 patients undergoing elective lumbar decompression and pedicle screw stabilisation evaluated the financial and clinical consequences of prolonged surgery. Patients were categorised by operative duration, comparing procedures completed within two hours against those exceeding two hours. Operations lasting more than two hours resulted in substantially higher average direct costs, amounting to approximately 2,718 US dollars compared to 1,910 US dollars for shorter procedures, creating an excess expense of roughly 808 US dollars per patient. Extended surgery times also corresponded with longer hospital admissions, averaging 8.4 days compared to 5.6 days, as well as a marked increase in postoperative complications from 8.6 percent to 23.4 percent. Multivariate analysis confirmed that operating time beyond two hours independently predicted higher overall hospital expenses after accounting for age and comorbid health conditions.
In resource-constrained healthcare environments, managing surgical expenses is critical for both institutions and patients. Quantifying the financial penalties and clinical risks of extended lumbar operations highlights the importance of theatre efficiency. Demonstrating that procedure duration directly drives expenses provides hospital managers with clear justification to adopt targeted operational measures that minimise time in surgery, lower patient complications, and conserve healthcare resources.
The findings provide actionable evidence for hospital administrators, healthcare consultants, and surgical departments seeking to improve operating theatre efficiency. Potential applications involve implementing surgical team optimisation programmes, targeted surgeon training, and implant standardisation to curb healthcare delivery costs. This represents applied operational research rather than a proprietary technology, which is ready for immediate practical consideration by clinical leaders seeking to standardise workflows and reduce expenditure in resource-limited surgical facilities.
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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.
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DOI: 10.18203/2349-3933.ijam20262824
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