Trends in the treatment of lumbar spine fractures in the United States: a socioeconomics perspective: clinical article.
ABSTRACT The objective of this study was to investigate a national health care database and analyze demographics, hospital charges, and treatment trends of patients diagnosed with lumbar spine fractures in the US over a 5-year period.
Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 2003 through 2007. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with lumbar spine fractures were identified using the appropriate ICD-9-CM code. Data on the number of vertebral body augmentation procedures were also retrieved. National estimates of discharges, hospital charges, discharge patterns, and treatment with spinal fusion trends were retrieved and analyzed.
More than 190,000 records of patients with lumbar spine fractures were abstracted from the database. During the 5-year period, there was a 17% increase in hospitalizations for lumbar spine fractures. This was associated with a 27% increase in hospital charges and a 55% increase in total national charges (both adjusted for inflation). The total health care bill associated with lumbar spine fractures in 2007 exceeded 1 billion US dollars. During this same time period, there was a 24% increase in spinal fusions for lumbar fractures, which was associated with a 15% increase in hospital charges. The ratio of spinal fusions to hospitalizations (surgical rate) during this period, however, was stable with an average of 7.4% over the 5-year period. There were an estimated 13,000 vertebral body augmentation procedures for nonpathological fractures performed in 2007 with a total national bill of 450 million US dollars.
An increasing trend of hospitalizations, surgical treatment, and charges associated with lumbar spine fractures was observed between 2003 and 2007 on a national level. This trend, however, does not appear to be as steep as that of surgical utilization in degenerative spine disease. Furthermore, the ratio of spinal fusions to hospitalizations for lumbar fractures appears to be stable, possibly indicating no significant changes in indications for surgical intervention over the time period studied.
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ABSTRACT: Treatment for traumatic central cord syndrome (TCCS) without bone injury is still controversial. The purpose of this study was to examine trends in the treatment for TCCS without bone injury in the United States. Clinical data were obtained from the US Nationwide Inpatient Sample from 2000 to 2009. Patients with TCCS without bone injury were identified and divided into those receiving surgical treatment and those receiving conservative treatment according to the International Classification of Diseases-9th Rev.-Clinical Modification codes. Patient and health care system-related demographic data were retrieved. Trends in the treatment and patient outcomes were analyzed. Multivariate logistic regression analysis was then performed to identify the predictors for surgical treatment. The ratio of patients who underwent surgical treatment was 27.1%. This ratio increased from 14.8% in 2000 to 30.5% in 2009 (p = 0.008). A total of 47.2% of surgical procedures were performed between Days 0 and 2. Multivariate analysis revealed that larger hospital size was a significant predictor for surgical treatment and patients who received treatment in Northeastern region were less likely to undergo surgical treatment. Comparisons between patients receiving surgical and conservative treatment revealed that those receiving surgical treatment had significantly higher overall in-hospital complication rate (18.6% vs. 14.5%), lower pulmonary embolism rate (0.5% vs. 1.2%), lower in-hospital mortality rate (2.0% vs. 2.7%), longer hospital stays (11.2 days vs. 9.9 days), and increased total hospital costs ($93,940 vs. $50,701). The ratio of patients who underwent surgical treatment for TCCS without bone injury increased from 2000 to 2009. Approximately half of surgical procedures were performed from Days 0 to 2. Patients who received treatment in a small hospital or the Northeastern region were less likely to undergo surgical treatment. Although the overall in-hospital complication rate was higher in patients with surgical treatment, pulmonary embolism and in-hospital mortality rates were higher in patients with conservative treatment than those in patients with surgical treatment. Prognostic and epidemiologic study, level III. Therapeutic study, level IV.Journal of Trauma and Acute Care Surgery 09/2013; 75(3):453-458. DOI:10.1097/TA.0b013e31829cfd7f · 1.97 Impact Factor
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ABSTRACT: Study Design. Retrospective Database AnalysisObjective. To investigate national trends of cervical spine surgical procedures from 2002-2011.Summary of Background Data. There is a paucity of literature assessing the current practice trends and outcomes of cervical spine surgery following the 2008 FDA public health notifications regarding bone morphogenetic protein (BMP) utilization in cervical spine surgical procedures.Methods. The National Inpatient Sample (NIS) database was accessed for each year across 2002-2011. Patients undergoing anterior cervical fusion (ACF), posterior cervical fusion (PCF), and posterior cervical decompression (PCD) were identified. Patient and hospitalization parameters including demographics, BMP utilization, costs, early post-operative outcomes, and mortality were assessed for each surgical cohort. A Pearson Correlation coefficient with a 95% confidence interval (p<0.05) was utilized to analyze trends in patient and hospital outcomes parameters during this 10-year period.Results. A total of 307,188 cervical spine procedures were performed from 2002-2011. Both the ACF and PCF cohort demonstrated a statistically significant increase in the number of procedures performed over time (r = +0.9, p<0.001). A significant uptrend in patient age (r = +1.0, p<0.001) and comorbidity burden (r = +0.9, p<0.001) was demonstrated during the studied decade. Overall, BMP utilization (r = +0.7, p = 0.02) also demonstrated a significant increase during this time period, but demonstrated a decline after peaking in 2007. The PCF cohort demonstrated the greatest comorbidity, length of stay, costs, and mortality.Conclusion. This study demonstrates that the number of cervical spine procedures has increased between 2002 and 2011, irrespective of the change in BMP utilization after the 2008 FDA warning. Despite an older patient population with greater comorbidities undergoing CSS, hospital length of stay (LOS) and mortality has not significantly changed. However, we did note a significant increase in costs during this time-period. These findings may be related to advances in surgical technology and instrumentation that may be associated with rising hospital costs.Spine 12/2013; 39(6). DOI:10.1097/BRS.0000000000000165 · 2.45 Impact Factor