Trends, major Medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults

Richard (Rick) Deyo, Sohail K. Mirza, Brook I. Martin, William Kreuter, David C. Goodman, Jeffrey G. Jarvik

Research output: Contribution to journalArticle

695 Citations (Scopus)

Abstract

Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over nonoperative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in older patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective To examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002-2007, focusing on 2007 to assess complications and resource use in US hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (1 or 2 disk levels, single surgical approach), or complex fusion (more than 2 disk levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002-2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100 000 beneficiaries. Lifethreatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50-3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR, 1.94; 95% CI, 1.74-2.17). Adjusted mean hospital charges for complex fusion procedures were US $80 888 compared with US $23 724 for decompression alone. Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.

Original languageEnglish (US)
Pages (from-to)1259-1265
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume303
Issue number13
DOIs
StatePublished - Apr 7 2010

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Spinal Stenosis
Decompression
Medicare
Comorbidity
Pathologic Constriction
Odds Ratio
Confidence Intervals
Hospital Charges
Mortality
Spine
Cohort Studies
Outcome Assessment (Health Care)
Growth

ASJC Scopus subject areas

  • Medicine(all)

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Trends, major Medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. / Deyo, Richard (Rick); Mirza, Sohail K.; Martin, Brook I.; Kreuter, William; Goodman, David C.; Jarvik, Jeffrey G.

In: JAMA - Journal of the American Medical Association, Vol. 303, No. 13, 07.04.2010, p. 1259-1265.

Research output: Contribution to journalArticle

Deyo, Richard (Rick) ; Mirza, Sohail K. ; Martin, Brook I. ; Kreuter, William ; Goodman, David C. ; Jarvik, Jeffrey G. / Trends, major Medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. In: JAMA - Journal of the American Medical Association. 2010 ; Vol. 303, No. 13. pp. 1259-1265.
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T1 - Trends, major Medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults

AU - Deyo, Richard (Rick)

AU - Mirza, Sohail K.

AU - Martin, Brook I.

AU - Kreuter, William

AU - Goodman, David C.

AU - Jarvik, Jeffrey G.

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N2 - Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over nonoperative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in older patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective To examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002-2007, focusing on 2007 to assess complications and resource use in US hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (1 or 2 disk levels, single surgical approach), or complex fusion (more than 2 disk levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002-2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100 000 beneficiaries. Lifethreatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50-3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR, 1.94; 95% CI, 1.74-2.17). Adjusted mean hospital charges for complex fusion procedures were US $80 888 compared with US $23 724 for decompression alone. Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.

AB - Context In recent decades, the fastest growth in lumbar surgery occurred in older patients with spinal stenosis. Trials indicate that for selected patients, decompressive surgery offers an advantage over nonoperative treatment, but surgeons often recommend more invasive fusion procedures. Comorbidity is common in older patients, so benefits and risks must be carefully weighed in the choice of surgical procedure. Objective To examine trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity. Design, Setting, and Patients Retrospective cohort analysis of Medicare claims for 2002-2007, focusing on 2007 to assess complications and resource use in US hospitals. Operations for Medicare recipients undergoing surgery for lumbar stenosis (n=32152 in the first 11 months of 2007) were grouped into 3 gradations of invasiveness: decompression alone, simple fusion (1 or 2 disk levels, single surgical approach), or complex fusion (more than 2 disk levels or combined anterior and posterior approach). Main Outcome Measures Rates of the 3 types of surgery, major complications, postoperative mortality, and resource use. Results Overall, surgical rates declined slightly from 2002-2007, but the rate of complex fusion procedures increased 15-fold, from 1.3 to 19.9 per 100 000 beneficiaries. Lifethreatening complications increased with increasing surgical invasiveness, from 2.3% among patients having decompression alone to 5.6% among those having complex fusions. After adjustment for age, comorbidity, previous spine surgery, and other features, the odds ratio (OR) of life-threatening complications for complex fusion compared with decompression alone was 2.95 (95% confidence interval [CI], 2.50-3.49). A similar pattern was observed for rehospitalization within 30 days, which occurred for 7.8% of patients undergoing decompression and 13.0% having a complex fusion (adjusted OR, 1.94; 95% CI, 1.74-2.17). Adjusted mean hospital charges for complex fusion procedures were US $80 888 compared with US $23 724 for decompression alone. Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.

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