Rates, costs, return to work and reoperation following spinal surgery in a workers’ compensation cohort in New South Wales, 2010–2018: a cohort study using administrative data

Abstract

Background Internationally, elective spinal surgery rates in workers’ compensation populations are high, as are reoperation rates, while return-to-work rates following spinal surgery are low. Little information is available from Australia. The aim of this study was to describe the rates, costs, return to work and reoperation following elective spinal surgery in the workers’ compensation population in New South Wales (NSW), Australia. Methods This retrospective cohort study used administrative data from the State Insurance Regulatory Authority, the government organisation responsible for regulating and administering workers’ compensation insurance in NSW. These data cover all workers’ compensation-insured workers in New South Wales (over 3 million workers/year). We identified a cohort of insured workers who underwent elective spinal surgery (fusion or decompression) between January 1, 2010 and December 31, 2018. People who underwent surgery for spinal fracture or dislocation, or who had sustained a traumatic brain injury were excluded. The main outcome measures were annual spinal surgery rates, cost of the surgical episode, cumulative costs (surgical, hospital, medical and physical therapy) to 2 years post-surgery, and reoperation and return-to-work rates 2 years post-surgery. Results There were 9343 eligible claims (39.1 % fusion; 59.9 % decompression); claimants were predominantly male (75 %) with a mean age of 43 (range 18 to 75) years. Spinal surgery rates ranged from 15 to 29 surgeries per 100,000 workers per year, fell from 2011-12 to 2014-15 and rose thereafter. The average cost in Australian dollars for a surgical episode was $46,000 for a spinal fusion and $20,000 for a decompression. Two years post-fusion, only 19 % of people had returned to work at full capacity; 39 % after decompression. Nineteen percent of patients underwent additional spinal surgery within 2 years of the index surgery, to a maximum of 5 additional surgeries. Conclusion Rates of workers’ compensation-funded spinal surgery did not rise significantly during the study period, but reoperation rates are high and return-to-work rates are low in this population at 2 years post- surgery. In the context of the poor evidence base supporting lumbar fusion surgery, the high cost, increasing rates, and the increased likelihood of poor outcomes in the workers’ compensation population, we question the value of this procedure in this setting.

The role of spinal surgery in the treatment of low back pain

“…The exponential growth of spinal fusion, particularly in the private sector, has driven (and is likely been driven by) a concomitant increase in the development of new implants and instrumentation techniques. 20,76 The detrimental association between industry and research is well documented across the medical literature and may, in part, explain the predominance of technique trials detailed previously. 77 A 2017 analysis of nearly 6000 North American spine surgeons found that 91.6% reported at least one financial relationship with industry.…”

“…Given the increasing frequency and complexity of spinal surgery, 20 it is essential to consider the cost to the health care system, with spinal fusions being recently estimated to cost $46 288 ± $22 112 per episode in Australia 76 . It is also essential to consider the role of industry and device manufacturers.…”

“…It is also essential to consider the role of industry and device manufacturers. The exponential growth of spinal fusion, particularly in the private sector, has driven (and is likely been driven by) a concomitant increase in the development of new implants and instrumentation techniques 20,76 . The detrimental association between industry and research is well documented across the medical literature and may, in part, explain the predominance of technique trials detailed previously 77 .…”

“…Given the increasing frequency and complexity of spinal surgery, 20 it is essential to consider the cost to the health care system, with spinal fusions being recently estimated to cost $46 288 ± $22 112 per episode in Australia. 76 It is also essential to consider the role of industry and device manufacturers. The exponential growth of spinal fusion, particularly in the private sector, has driven (and is likely been driven by) a concomitant increase in the development of new implants and instrumentation techniques.…”

Comparison of Trends in the Incidence of Traumatic Spinal Cord Injury in Daily Life, Automobile Accidents, and Industrial Accidents: A National Multi-Insurance Study in Korea

“…However, even in countries with national health insurance, the medical systems and coverage for trauma patients is different from country to country, for instance, the German Statutory Accident Insurance, 5 Swiss Accident Insurance, 6 and State Insurance Regulatory Agency in the Australian state of New South Wales. 7 In this regard, South Korea has one of the best national health insurance systems in the world. South Korea provides universal medical coverage to all citizens without omission, from birth to death, through the national health insurance system.…”