Changes in Utilization of Spinal Fusionin the United States

Cowan, John A.; Dimick, Justin B.; Wainess, Reid M.; Upchurch, Gilbert R.; Chandler, William F.; Marca, Frank La

doi:10.1227/01.neu.0000219836.54861.cd

Cited by 160 publications

(86 citation statements)

References 7 publications

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“…Because hospital reimbursement is often based on a diagnosis-related group fee schedule, it is possible coding could be selected in a manner such that the maximally reimbursed code is listed as the primary diagnosis for admission. Although such potential for variability can typically be equalized by the volume of patients included in the NIS, we followed precedent to include only encounters in which VCF was listed as the primary admission diagnosis [10,15,26]. Second, any research using the NIS database cannot assess traditionally supported and validated outcome measures such as 30-day and 1-year mortality, pain scores, and outcome questionnaires (SF-36, Oswestry Disability Index, and others).…”

Section: Discussionmentioning

confidence: 99%

“…This database has been used to evaluate use trends and outcomes for a variety of procedures in spine surgery [1,5,10,15,20,26,28,33,36,47,52,59] as well as the impact of comorbidities on the outcome of spine procedures [3,11,17,18]. Such a database allows a larger patient sample to be amassed in relatively short period of time and for a lower cost than could be achieved by even a large multicenter trial; they also can offer insight into the actual use, complications, and outcomes of a procedure in ''real life'' and without the restrictive criteria imposed for inclusion in controlled trials.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Zampini

White

McGuire

2010

Clinical Orthopaedics &Amp; Related Research

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Background The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources. Questions/purposes We evaluated complications, mortality, posthospital disposition, and treatment costs of kyphoplasty compared with nonoperative treatment using the Nationwide Inpatient Sample database.Methods We identified 5766 VCFs (71% female) in patients 65 years of age or older with nonneoplastic VCF as the primary diagnosis in nonroutine hospital admissions; 15.3% underwent kyphoplasty. Demographic data, medical comorbidities, and fracture treatment type were recorded. Outcomes, including complications, mortality, posthospital disposition, and treatment costs, were compared for each treatment type. Results Women were more likely to be treated with kyphoplasty than were men. Patients undergoing kyphoplasty had comorbidity indices equivalent to those treated nonoperatively. Kyphoplasty was associated with a greater likelihood of routine discharge to home (38.4% versus 21.0% for nonoperative treatment), a lower rate of discharge to skilled nursing (26.1% versus 34.8%) or other facilities (35.7% versus 47.1%), a complication rate equivalent to nonoperative treatment (1.7% versus 1.0%), and a lower rate of in-hospital mortality (0.3% versus 1.6%). Kyphoplasty was associated with higher cost of hospitalization (mean $37,231 versus $20,112).

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Zampini

White

McGuire

2010

Clinical Orthopaedics &Amp; Related Research

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“…First, the aging population will increase the utilization of lumbar spine fusion surgeries [6]. This trend is likely to increase the absolute number of deaths associated with this surgery, even if overall mortality rates remain unchanged.…”

Section: Introductionmentioning

confidence: 99%

Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors

Pumberger

Chiu

et al. 2012

Eur Spine J

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Study design Analysis of the Nationwide Inpatient Sample (NIS) from 1998 to 2008.Objective To analyze the most recent available and nationally representative data for risk factors contributing to in-hospital mortality after primary lumbar spine fusion. Summary of background data The total number of lumbar spine fusion surgeries has increased dramatically over the past decades. While the field of spine fusion surgery remains highly dynamic with changes in perioperative care constantly affecting patient care, recent data affecting rates and risk for perioperative mortality remain very limited. Methods We obtained the NIS from the Hospital cost and utilization project. The impact of patient and health care system related demographics, including various comorbidities as well as postoperative complications on the outcome of in-hospital mortality after spine fusion were studied. Furthermore, we analyzed the timing of in-hospital mortality.Results An estimated total of 1,288,496 primary posterior lumbar spine fusion procedures were performed in the US between 1998 and 2008. The average mortality rate for lumbar spine fusion surgery was 0.2 %. Independent risk factors for in-hospital mortality included advanced age, male gender, large hospital size, and emergency admission. Comorbidities associated with the highest in-hospital mortality after lumbar spine fusion surgery were coagulopathy, metastatic cancer, congestive heart failure and renal disease. Most lethal complications were cerebrovascular events, sepsis and pulmonary embolism. Furthermore, we demonstrated that the timing of death occurred relatively early in the in-hospital period with over half of fatalities occurring by postoperative day 9. Conclusion This study provides nationally representative information on risk factors for and timing of perioperative mortality after primary lumbar spine fusion surgery. These data can be used to assess risk for this event and to develop targeted intervention to decrease such risk.

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“…Other indications include trauma and neoplastic disease. In the time period between 1988 and 2001, the number of spine fusions in the United States increased from some 24 000 to more than 120 000 procedures per year [9,10] ; degenerative disc disease as a primary diagnosis was present in almost two thirds of cases (65.3%) by 2001 [11] . Taking a closer look at the available data, the rate of surgery increased by approximately 100% during the 1980s and more than 220% during the 1990s.…”

Section: Epidemiologymentioning

confidence: 99%

“…After 1996, when intervertebral fusion cages received approval by the food and drug administration, an exponential increase in case burden was seen. In 2001, depending on age group, as many as 60 to 90 per 100 000 patients underwent cervical, thoracic or lumbar spine fusion [11] . The most dramatic rise was evident in the group of patients aged 60 or older in all procedures except cervical spinal fusion, which peaked in the group aged 40 to 59 years [9] .…”

Section: Epidemiologymentioning

confidence: 99%

Pulmonary complications after spine surgery

Stundner¹

2012

WJO

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Spine surgery is one of the fastest growing branches of orthopedic surgery. Patients often present with a relatively high acuity and, depending on surgical approach, morbidity and mortality can be comparatively high. Among the most prevalent and most frequently fatalitybound perioperative complications are those affecting the pulmonary system; evidence of clinical or subclinical lung injury triggered by spine surgical procedures is emerging. Increasing burden of comorbidity among the patient population further increases the likelihood of adverse outcome. This review is intended to give an overview over some of the most important causes of pulmonary complications after spine surgery, their pathophysiology and possible ways to reduce harm associated with those conditions. We discuss factors surrounding surgical trauma, timing of surgery, bone marrow and debris embolization, transfusion associated lung injury, and ventilator associated lung injury.

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Changes in Utilization of Spinal Fusionin the United States

Cited by 160 publications

References 7 publications

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Perioperative mortality after lumbar spinal fusion surgery: an analysis of epidemiology and risk factors

Pulmonary complications after spine surgery

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