Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis

Gustavo C. Machado, Chris G. Maher, Paulo H. Ferreira, Ian A. Harris, Richard (Rick) Deyo, Damien McKay, Qiang Li, Manuela L. Ferreira

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

STUDY DESIGN.: Population based health record linkage study. OBJECTIVE.: To determine trends in hospital admissions and surgery for lumbar spinal stenosis, as well as complications and resource use in Australia. SUMMARY OF BACKGROUND DATA.: In the United States, rates of decompression surgery have declined, whereas those of fusion have increased. It is unclear whether this trend is also happening elsewhere. METHODS.: We included patients 18 years and older admitted to a hospital in New South Wales between 2003–2013, who were diagnosed with lumbar spinal stenosis. We investigated the rates of hospital admission and surgical procedures, as well as hospital costs, length of hospital stay, and complications. Surgical procedures were: decompression alone, simple fusion (1–2 disc levels, single approach), and complex fusion (≥3 disc levels or a combined posterior and anterior approach). RESULTS.: The rates of decompression surgery increased from 19.0 to 22.1 per 100,000 people. Simple fusion rates increased from 1.3 to 2.8 per 100,000 people, while complex fusion increased from 0.6 to 2.4 per 100,000 people. The odds of major complications for complex fusion compared with decompression alone was 4.1 (95% CI: 1.7–10.1), though no difference was found for simple fusion (OR 2.0, 95% CI: 0.7–6.1). Mean hospital costs with decompression surgery were AU $12,168, while simple and complex fusion cost AU $30,811 and AU $32,350, respectively. CONCLUSIONS.: In Australia, decompression rates for lumbar spinal stenosis increased from 2003–2013. The fastest increasing surgical procedure was complex fusion. This procedure increased the risk of major complications and resource, though recent evidence suggest fusion provides no additional benefits to the traditional decompression surgery.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Apr 24 2017

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Spinal Stenosis
Hospital Costs
Decompression
Length of Stay
New South Wales
Costs and Cost Analysis
Health
Population

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Machado, G. C., Maher, C. G., Ferreira, P. H., Harris, I. A., Deyo, R. R., McKay, D., ... Ferreira, M. L. (Accepted/In press). Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis. Spine. https://doi.org/10.1097/BRS.0000000000002207

Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis. / Machado, Gustavo C.; Maher, Chris G.; Ferreira, Paulo H.; Harris, Ian A.; Deyo, Richard (Rick); McKay, Damien; Li, Qiang; Ferreira, Manuela L.

In: Spine, 24.04.2017.

Research output: Contribution to journalArticle

Machado, Gustavo C. ; Maher, Chris G. ; Ferreira, Paulo H. ; Harris, Ian A. ; Deyo, Richard (Rick) ; McKay, Damien ; Li, Qiang ; Ferreira, Manuela L. / Trends, Complications, and Costs for Hospital Admission and Surgery for Lumbar Spinal Stenosis. In: Spine. 2017.
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abstract = "STUDY DESIGN.: Population based health record linkage study. OBJECTIVE.: To determine trends in hospital admissions and surgery for lumbar spinal stenosis, as well as complications and resource use in Australia. SUMMARY OF BACKGROUND DATA.: In the United States, rates of decompression surgery have declined, whereas those of fusion have increased. It is unclear whether this trend is also happening elsewhere. METHODS.: We included patients 18 years and older admitted to a hospital in New South Wales between 2003–2013, who were diagnosed with lumbar spinal stenosis. We investigated the rates of hospital admission and surgical procedures, as well as hospital costs, length of hospital stay, and complications. Surgical procedures were: decompression alone, simple fusion (1–2 disc levels, single approach), and complex fusion (≥3 disc levels or a combined posterior and anterior approach). RESULTS.: The rates of decompression surgery increased from 19.0 to 22.1 per 100,000 people. Simple fusion rates increased from 1.3 to 2.8 per 100,000 people, while complex fusion increased from 0.6 to 2.4 per 100,000 people. The odds of major complications for complex fusion compared with decompression alone was 4.1 (95{\%} CI: 1.7–10.1), though no difference was found for simple fusion (OR 2.0, 95{\%} CI: 0.7–6.1). Mean hospital costs with decompression surgery were AU $12,168, while simple and complex fusion cost AU $30,811 and AU $32,350, respectively. CONCLUSIONS.: In Australia, decompression rates for lumbar spinal stenosis increased from 2003–2013. The fastest increasing surgical procedure was complex fusion. This procedure increased the risk of major complications and resource, though recent evidence suggest fusion provides no additional benefits to the traditional decompression surgery.Level of Evidence: 3",
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N2 - STUDY DESIGN.: Population based health record linkage study. OBJECTIVE.: To determine trends in hospital admissions and surgery for lumbar spinal stenosis, as well as complications and resource use in Australia. SUMMARY OF BACKGROUND DATA.: In the United States, rates of decompression surgery have declined, whereas those of fusion have increased. It is unclear whether this trend is also happening elsewhere. METHODS.: We included patients 18 years and older admitted to a hospital in New South Wales between 2003–2013, who were diagnosed with lumbar spinal stenosis. We investigated the rates of hospital admission and surgical procedures, as well as hospital costs, length of hospital stay, and complications. Surgical procedures were: decompression alone, simple fusion (1–2 disc levels, single approach), and complex fusion (≥3 disc levels or a combined posterior and anterior approach). RESULTS.: The rates of decompression surgery increased from 19.0 to 22.1 per 100,000 people. Simple fusion rates increased from 1.3 to 2.8 per 100,000 people, while complex fusion increased from 0.6 to 2.4 per 100,000 people. The odds of major complications for complex fusion compared with decompression alone was 4.1 (95% CI: 1.7–10.1), though no difference was found for simple fusion (OR 2.0, 95% CI: 0.7–6.1). Mean hospital costs with decompression surgery were AU $12,168, while simple and complex fusion cost AU $30,811 and AU $32,350, respectively. CONCLUSIONS.: In Australia, decompression rates for lumbar spinal stenosis increased from 2003–2013. The fastest increasing surgical procedure was complex fusion. This procedure increased the risk of major complications and resource, though recent evidence suggest fusion provides no additional benefits to the traditional decompression surgery.Level of Evidence: 3

AB - STUDY DESIGN.: Population based health record linkage study. OBJECTIVE.: To determine trends in hospital admissions and surgery for lumbar spinal stenosis, as well as complications and resource use in Australia. SUMMARY OF BACKGROUND DATA.: In the United States, rates of decompression surgery have declined, whereas those of fusion have increased. It is unclear whether this trend is also happening elsewhere. METHODS.: We included patients 18 years and older admitted to a hospital in New South Wales between 2003–2013, who were diagnosed with lumbar spinal stenosis. We investigated the rates of hospital admission and surgical procedures, as well as hospital costs, length of hospital stay, and complications. Surgical procedures were: decompression alone, simple fusion (1–2 disc levels, single approach), and complex fusion (≥3 disc levels or a combined posterior and anterior approach). RESULTS.: The rates of decompression surgery increased from 19.0 to 22.1 per 100,000 people. Simple fusion rates increased from 1.3 to 2.8 per 100,000 people, while complex fusion increased from 0.6 to 2.4 per 100,000 people. The odds of major complications for complex fusion compared with decompression alone was 4.1 (95% CI: 1.7–10.1), though no difference was found for simple fusion (OR 2.0, 95% CI: 0.7–6.1). Mean hospital costs with decompression surgery were AU $12,168, while simple and complex fusion cost AU $30,811 and AU $32,350, respectively. CONCLUSIONS.: In Australia, decompression rates for lumbar spinal stenosis increased from 2003–2013. The fastest increasing surgical procedure was complex fusion. This procedure increased the risk of major complications and resource, though recent evidence suggest fusion provides no additional benefits to the traditional decompression surgery.Level of Evidence: 3

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