Population-based trends in volumes and rates of ambulatory lumbar spine surgery

Darryl T. Gray, Richard (Rick) Deyo, William Kreuter, Sohail K. Mirza, Patrick J. Heagerty, Bryan A. Comstock, Leighton Chan

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

STUDY DESIGN. Sequential cross-sectional study. OBJECTIVES. To quantify patterns of outpatient lumbar spine surgery. SUMMARY OF BACKGROUND DATA. Outpatient lumbar spine surgery patterns are undocumented. METHODS. We used CPT-4 and ICD-9-CM diagnosis/procedure codes to identify lumbar spine operations in 20+ year olds. We combined sample volume estimates from the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) with complete case counts from HCUP's State Inpatient Databases (SIDs) and State Ambulatory Surgery Databases (SASDs) for four geographically diverse states. We excluded pregnant patients and those with vertebral fractures, cancer, trauma, or infection. We calculated age- and sex-adjusted rates. RESULTS. Ambulatory cases comprised 4% to 13% of procedures performed from 1994 to 1996 (NHDS/NSAS data), versus 9% to 17% for 1997 to 2000 (SID/SASD data). Discectomies comprised 70% to 90% of outpatient cases. Conversely, proportions of discectomies performed on outpatients rose from 4% in 1994 to 26% in 2000. Outpatient fusions and laminectomies were uncommon. NIS data indicate that nationwide inpatient surgery rates were stable (159 cases/100,000 in 1994 vs. 162/100,000 in 2000). However, combined data from all sources suggest that inpatient and outpatient rates rose from 164 cases/100,000 in 1994 to 201/100,000 in 2000. CONCLUSIONS. While inpatient lumbar surgery rates remained relatively stable for 1994 to 2000, outpatient surgery increased over time.

Original languageEnglish (US)
Pages (from-to)1957-1963
Number of pages7
JournalSpine
Volume31
Issue number17
DOIs
StatePublished - Aug 2006
Externally publishedYes

Fingerprint

Inpatients
Spine
Ambulatory Surgical Procedures
Outpatients
Population
Databases
Health Care Surveys
Diskectomy
Laminectomy
Information Storage and Retrieval
International Classification of Diseases
Health Care Costs
Cross-Sectional Studies
Wounds and Injuries
Infection
Neoplasms

Keywords

  • Ambulatory surgery
  • Discectomy
  • Fusion
  • Healthcare Cost and Utilization Project (HCUP)
  • Lumbar spine surgery
  • Nationwide Inpatient Sample (NIS)
  • Outpatient surgery
  • Rate trends
  • State Ambulatory Surgery Database (SASD)
  • State Inpatient Database (SID)

ASJC Scopus subject areas

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Gray, D. T., Deyo, R. R., Kreuter, W., Mirza, S. K., Heagerty, P. J., Comstock, B. A., & Chan, L. (2006). Population-based trends in volumes and rates of ambulatory lumbar spine surgery. Spine, 31(17), 1957-1963. https://doi.org/10.1097/01.brs.0000229148.63418.c1

Population-based trends in volumes and rates of ambulatory lumbar spine surgery. / Gray, Darryl T.; Deyo, Richard (Rick); Kreuter, William; Mirza, Sohail K.; Heagerty, Patrick J.; Comstock, Bryan A.; Chan, Leighton.

In: Spine, Vol. 31, No. 17, 08.2006, p. 1957-1963.

Research output: Contribution to journalArticle

Gray, DT, Deyo, RR, Kreuter, W, Mirza, SK, Heagerty, PJ, Comstock, BA & Chan, L 2006, 'Population-based trends in volumes and rates of ambulatory lumbar spine surgery', Spine, vol. 31, no. 17, pp. 1957-1963. https://doi.org/10.1097/01.brs.0000229148.63418.c1
Gray, Darryl T. ; Deyo, Richard (Rick) ; Kreuter, William ; Mirza, Sohail K. ; Heagerty, Patrick J. ; Comstock, Bryan A. ; Chan, Leighton. / Population-based trends in volumes and rates of ambulatory lumbar spine surgery. In: Spine. 2006 ; Vol. 31, No. 17. pp. 1957-1963.
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abstract = "STUDY DESIGN. Sequential cross-sectional study. OBJECTIVES. To quantify patterns of outpatient lumbar spine surgery. SUMMARY OF BACKGROUND DATA. Outpatient lumbar spine surgery patterns are undocumented. METHODS. We used CPT-4 and ICD-9-CM diagnosis/procedure codes to identify lumbar spine operations in 20+ year olds. We combined sample volume estimates from the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) with complete case counts from HCUP's State Inpatient Databases (SIDs) and State Ambulatory Surgery Databases (SASDs) for four geographically diverse states. We excluded pregnant patients and those with vertebral fractures, cancer, trauma, or infection. We calculated age- and sex-adjusted rates. RESULTS. Ambulatory cases comprised 4{\%} to 13{\%} of procedures performed from 1994 to 1996 (NHDS/NSAS data), versus 9{\%} to 17{\%} for 1997 to 2000 (SID/SASD data). Discectomies comprised 70{\%} to 90{\%} of outpatient cases. Conversely, proportions of discectomies performed on outpatients rose from 4{\%} in 1994 to 26{\%} in 2000. Outpatient fusions and laminectomies were uncommon. NIS data indicate that nationwide inpatient surgery rates were stable (159 cases/100,000 in 1994 vs. 162/100,000 in 2000). However, combined data from all sources suggest that inpatient and outpatient rates rose from 164 cases/100,000 in 1994 to 201/100,000 in 2000. CONCLUSIONS. While inpatient lumbar surgery rates remained relatively stable for 1994 to 2000, outpatient surgery increased over time.",
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AB - STUDY DESIGN. Sequential cross-sectional study. OBJECTIVES. To quantify patterns of outpatient lumbar spine surgery. SUMMARY OF BACKGROUND DATA. Outpatient lumbar spine surgery patterns are undocumented. METHODS. We used CPT-4 and ICD-9-CM diagnosis/procedure codes to identify lumbar spine operations in 20+ year olds. We combined sample volume estimates from the National Hospital Discharge Survey (NHDS), the National Survey of Ambulatory Surgery (NSAS), and the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) with complete case counts from HCUP's State Inpatient Databases (SIDs) and State Ambulatory Surgery Databases (SASDs) for four geographically diverse states. We excluded pregnant patients and those with vertebral fractures, cancer, trauma, or infection. We calculated age- and sex-adjusted rates. RESULTS. Ambulatory cases comprised 4% to 13% of procedures performed from 1994 to 1996 (NHDS/NSAS data), versus 9% to 17% for 1997 to 2000 (SID/SASD data). Discectomies comprised 70% to 90% of outpatient cases. Conversely, proportions of discectomies performed on outpatients rose from 4% in 1994 to 26% in 2000. Outpatient fusions and laminectomies were uncommon. NIS data indicate that nationwide inpatient surgery rates were stable (159 cases/100,000 in 1994 vs. 162/100,000 in 2000). However, combined data from all sources suggest that inpatient and outpatient rates rose from 164 cases/100,000 in 1994 to 201/100,000 in 2000. CONCLUSIONS. While inpatient lumbar surgery rates remained relatively stable for 1994 to 2000, outpatient surgery increased over time.

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KW - Rate trends

KW - State Ambulatory Surgery Database (SASD)

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