2012년 10월 6일 토요일

Spinal Fusion in the United States

Health Services Research
Spine 2012;37:67–76

Title: Spinal Fusion in the United States
          Analysis of Trends From 1998 to 2008


Authors
Sean S. Rajaee
Hyun W. Bae
Linda E.A. Kanim
Rick B. Delamarter

Study Design.
Epidemiological study using national administrative data.

Objective.
1. To provide a complete analysis of national trends in spinal fusion from 1998 to 2008
2. To compare those in spinal fusion with trends in laminectomy, hip replacement, knee arthroplasty, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft.

Summary of Background Data.
Previous studies à rapid increase in volume of spinal fusions in US prior to 2001
But limited reports exist beyond this point, analyzing all spinal fusion procedures collectively.

Methods.
1. Data à Healthcare Cost and Utilization Project Nationwide Inpatient Sample (1998~2008)
2. Discharges were identified using International Classification of Diseases, Ninth Revision,
 Clinical Modification procedure codes for the following procedures: spinal fusion,
laminectomy, hip replacement, knee arthroplasty, percutaneous transluminal coronary
angioplasty, and coronary artery bypass graft.
3. Population-based utilization rates were calculated from the US census data.

Results.
Between 1998 and 2008, the annual number of spinal fusion discharges increased 2.4-fold (137%) from 174,223 to 413,171 (P< 0.001).
In contrast, laminectomy, hip replacement, knee arthroplasty, and percutaneous coronary angioplasty yielded relative increases of only 11.3%, 49.1%, 126.8%, and 38.8% in discharges, while coronary artery bypass graft experienced a decrease of 40.1%.

Between 1998 and 2008, mean age for spinal fusion increased from 48.8 to 54.2 years (P< 0.001), in-hospital mortality rate decreased from 0.29% to 0.25% (P< 0.01), and mean total hospital charges associated with spinal fusion increased 3.3-fold (P < 0.001).

The national bill for spinal fusion increased 7.9- fold (P< 0.001).

Conclusion.
Frequency, utilization, and hospital charges of spinal fusion have increased at a higher rate than other notable inpatient procedures, as seen in this study from 1998 to 2008.
In addition, patient demographics and hospital characteristics changed significantly; in particular, whereas the average age for spinal fusion increased, the in hospital mortality rate decreased.

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