Trends in the surgical treatment for spinal metastasis and the in-hospital patient outcomes in the United States from 2000 to 2009

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases. Electronic address: .
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 11/2013; 14(9). DOI: 10.1016/j.spinee.2013.11.029
Source: PubMed


Surgical treatment for spinal metastasis is still controversial. However, with the improvements in treatment for primary tumors, the survival of patients with spinal metastasis is enhanced. At the same time, surgical technique for spinal metastasis has also improved.
To examine trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes on a national level STUDY DESIGN/SETTING: Epidemiological study using national administrative data, Nationwide Inpatient Sample (NIS) PATIENT SAMPLE: All discharges included in the NIS with a diagnosis code of secondary malignant neoplasm of the spinal cord/brain, meninges, or bone who also underwent spinal surgery from 2000 to 2009 OUTCOME MEASURES: Trends in the surgical treatment for spinal metastasis, in-hospital complications and mortality, and resource use METHODS: The NIS was used to identify patients who underwent surgical treatment for spinal metastasis from 2000 to 2009, using the International Classification of Diseases, 9(th) revision, Clinical Modification (ICD-9-CM) codes. Trends in the surgical treatment for spinal metastasis and in-hospital patient outcomes were analyzed.
From 2000 to 2009, there was an increasing trend in the population growth-adjusted rate of surgical treatment for spinal metastasis (1.15 to 1.77 per 100 000, p < 0.001). Average Elixhauser Comorbidity Score increased over time (2.6 to 3.8, p < 0.001), and overall in-hospital complication rate increased over time (14.8% to 27.7%, p < 0.001), while in-hospital mortality rate and length of hospital stay remained stable over time (5.2% to 4.6%, p = 0.413) (10.6 days to 10.8 days, p = 0.626). Inflation-adjusted mean hospital charges increased more than 2-fold over time ($50390 to $110173, p < 0.001).
During the last decade, surgical treatment for spinal metastasis has increased in the US. The overall in-hospital complication rate and hospital charges increased, whereas the in-hospital mortality rate and length of hospital stay remained stable.

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