David C Sing1, Ryan Khanna2, Jeremy D Shaw1, Lionel N Metz1, Shane Burch1, Sigurd H Berven3. 1. Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA. 2. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA. 3. Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA. Electronic address: bervenS@orthosurg.ucsf.edu.
Abstract
STUDY DESIGN: Retrospective analysis of Nationwide Inpatient Sample (NIS) database. OBJECTIVE: To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011. SUMMARY OF BACKGROUND DATA: Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear. METHODS: Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data. RESULTS: A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p < .001). Utilization rates in patients 65-69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001). CONCLUSIONS: Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure. LEVEL OF EVIDENCE: III.
STUDY DESIGN: Retrospective analysis of Nationwide Inpatient Sample (NIS) database. OBJECTIVE: To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011. SUMMARY OF BACKGROUND DATA: Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear. METHODS: Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data. RESULTS: A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p < .001). Utilization rates in patients 65-69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001). CONCLUSIONS: Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure. LEVEL OF EVIDENCE: III.
Authors: John M Ibrahim; Paramjit Singh; Daniel Beckerman; Serena S Hu; Bobby Tay; Vedat Deviren; Shane Burch; Sigurd H Berven Journal: Global Spine J Date: 2019-05-19