Dramatic rise seen in complex stenosis surgeries performed in older adults

While the overall rates of Medicare beneficiaries who underwent simple decompressions and fusion surgeries declined slightly between 2002 and 2007, a recent study published in the Journal of the American Medical Association found that patients in this population more frequently underwent complex lumbar fusion procedures for spinal stenosis during that time.

In their retrospective study, Richard A. Deyo, MD, MPH, and colleagues detected a 15-fold increase in rates of complex fusions, which rose from 1.3 to 1.9 procedures per 100,000 Medicare beneficiaries during the time period studied.

“It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just 6 years,” investigators commented in their study.

Three groups studied

Deyo and his colleagues analyzed Medicare claims for the 6-year period in question, but mostly focused on data for 2007 to assess complications and resource use in U.S. hospitals for these procedures. They examined trends in the use of various surgical procedures for lumbar stenosis and associated complications and health care use, according to a press release from the American Medical Association.
The investigators categorized 32,152 Medicare recipients who underwent lumbar stenosis surgery during the first 11 months of 2007 into the following three groups based on the type and severity of surgery they had:

• decompression alone (group 1);
• simple fusion involving one or two disc levels using a single surgical approach (group 2); and
• complex fusion involving more than two disc levels or combined anterior and posterior surgical approaches (group 3).

The analysis revealed that the overall number of lumbar stenosis operations per 100,000 Medicare recipients declined from 137.4 in 2002 to 135.5 in 2007. Yet, at the same time, the number of more complex stenosis surgeries performed in that population rose dramatically.

Increase in complications

The investigators also noticed that the risk of life-threatening postoperative complications increased as the severity of the surgery increased. The complication risk was 2.3% in patients in group 1 compared to 5.6% for those in group 3. The authors noted that this finding was not surprising given the more extensive decortications and dissections done during complex fusions, which also require longer operative times.
The rates of hospital re-admissions within 30 days and the adjusted mean hospital charges were also greater for the more complex fusion cases.
“The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications,” the investigators wrote.

• Reference:

Deyo RA, Mirza SK, Martin BI, et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA.
Source: Posted on the ORTHO SuperSite April 12, 2010