Trends in the treatment of lumbar spine fractures in the United States: a socioeconomics perspective: clinical article.

Department of Neurosurgery, University of South Florida, Tampa, Florida, USA.
Journal of neurosurgery. Spine (Impact Factor: 1.61). 07/2011; 15(4):367-70. DOI: 10.3171/2011.5.SPINE10934
Source: PubMed

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.

  • [Show abstract] [Hide abstract]
    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; · 2.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent trends in U.S. breast oncology and autologous reconstruction, such as greater use of contralateral prophylactic mastectomies and microsurgery, may have increased reconstructive complication rates and costs. Simultaneously, with the increased complexity of autologous reconstruction in the setting of declining reimbursement, there may be market concentration of these procedures to specialized high-volume centers. This study aimed to (1) measure cost of autologous reconstruction in the setting of microsurgical technique, contralateral prophylactic mastectomies, and high-volume centers; and (2) analyze trends in market share of these procedures. Inflation-adjusted hospital charges were analyzed for autologous procedures using the Nationwide Inpatient Sample database (1998 to 2010), including a subgroup of microsurgical cases. Median charges were adjusted by patient case mix and analyzed by outcome, procedure type, and hospital volume using the Mann-Whitney test. Market share was evaluated through examination of trends in hospitals performing autologous reconstruction and procedures at high-volume centers. Median charges for 21,016 autologous reconstructions were $22,198. Costs were higher for bilateral reconstruction ($34,202) and microsurgical cases ($57,449). Hospital charges increased from $20,315 (no complications) to $42,210 when both surgery-specific and systemic complications were present (p < 0.01). High-volume hospitals reduced charges by 7.5 percent and had lower costs in the setting of complications (p < 0.01). The number of hospitals performing autologous reconstructions decreased 35 percent, with increasing annual procedures in high-volume centers (48.3 to 73.3, p < 0.01). Bilateral reconstructions and microsurgical technique are associated with greater health care costs. The market concentration of autologous reconstruction to high-volume centers is associated with reduced charges. The long-term implications of this trend are unknown.
    Plastic and reconstructive surgery 03/2014; 133(3):463-70. · 2.74 Impact Factor