Alexander Beschloss1, Christina Dicindio, Joseph Lombardi, Arya Varthi, Ali Ozturk, Ronald Lehman, Lawrence Lenke, Comron Saifi. 1. Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, Philadelphia, PA United States Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, New York, NY United States Department of Orthopaedic Surgery, Yale School of Medicine, New Haven, CT United States Department of Neurological Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA United States.
Abstract
STUDY DESIGN: Retrospective Cohort Database Study. OBJECTIVE: To investigate trends in utilization and demographics in Spinal Deformity Surgery. SUMMARY OF BACKGROUND DATA: The aging population in the United States will likely result in increased incidence of adult degenerative scoliosis. With a national focus on resource utilization and value-based care, it is essential for surgeons, researchers, and health care policy makers to know utilization and demographic trends of spinal surgery with long fusion construct. METHODS: The National Inpatient Sample (NIS) database was queried for patients who underwent fusion or refusion of ≥ 9 vertebrae (ICD-9-CM 81.64) between 2004 and 2015 across 44 states. Demographic and economic data, which includes annual number of surgeries, incidence, patient age, sex, region, insurance type, charge, routine discharge, LOS and data. The NIS database represents a 20% sample of discharges from U.S. hospitals, excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national estimates. RESULT: In 2014, there were 14,615 fusions involving ≥ 9 vertebrae across the United States. The number of fusions involving 9 or more levels has increased 141% from 6,072 in 2004. Long fusion constructs increased 460% from 2004 to 2014 amongst patients 65 to 84 years old. The mean hospital costs associated with long fusion spine surgery was $69,546 per case in 2015. Between 2004 and 2014, the payer breakdown for individuals receiving spinal deformity surgery is as follows: 54.2% private insurance, 18% Medicare and 21.2% Medicaid. CONCLUSIONS: The massive increase (141%) in utilization of long construct spine fusion was primarily driven by 460% rise in incidence of the surgery amongst those aged 65 to 84. While the cause is unknown, it is possible that this rise was, at least in part, driven by the implementation of the affordable care act, improved surgical safety, and better knowledge of spinopelvic parameters.Level of Evidence: 3.
STUDY DESIGN: Retrospective Cohort Database Study. OBJECTIVE: To investigate trends in utilization and demographics in Spinal Deformity Surgery. SUMMARY OF BACKGROUND DATA: The aging population in the United States will likely result in increased incidence of adult degenerative scoliosis. With a national focus on resource utilization and value-based care, it is essential for surgeons, researchers, and health care policy makers to know utilization and demographic trends of spinal surgery with long fusion construct. METHODS: The National Inpatient Sample (NIS) database was queried for patients who underwent fusion or refusion of ≥ 9 vertebrae (ICD-9-CM 81.64) between 2004 and 2015 across 44 states. Demographic and economic data, which includes annual number of surgeries, incidence, patient age, sex, region, insurance type, charge, routine discharge, LOS and data. The NIS database represents a 20% sample of discharges from U.S. hospitals, excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national estimates. RESULT: In 2014, there were 14,615 fusions involving ≥ 9 vertebrae across the United States. The number of fusions involving 9 or more levels has increased 141% from 6,072 in 2004. Long fusion constructs increased 460% from 2004 to 2014 amongst patients 65 to 84 years old. The mean hospital costs associated with long fusion spine surgery was $69,546 per case in 2015. Between 2004 and 2014, the payer breakdown for individuals receiving spinal deformity surgery is as follows: 54.2% private insurance, 18% Medicare and 21.2% Medicaid. CONCLUSIONS: The massive increase (141%) in utilization of long construct spine fusion was primarily driven by 460% rise in incidence of the surgery amongst those aged 65 to 84. While the cause is unknown, it is possible that this rise was, at least in part, driven by the implementation of the affordable care act, improved surgical safety, and better knowledge of spinopelvic parameters.Level of Evidence: 3.
Authors: Wesley M Durand; Carlos D Ortiz-Babilonia; Daniel Badin; Kevin Y Wang; Amit Jain Journal: J Am Acad Orthop Surg Date: 2022-06-06 Impact factor: 4.000