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Lumbar Spinal Fusion: A Cohort Study of Complications, Reoperations, and Resource Use in the Medicare Population

Deyo, Richard A., MD, MPH*†‡; Ciol, Marcia A., PhD; Cherkin, Daniel C., PhD†‡**; Loeser, John D., MD§; Bigos, Stanley J., MD

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Regional variations in lumbar spinal fusion rates suggest a poor consensus on surgical indications. Therefore, complications, costs, and reoperation rates were compared for elderly patients undergoing surgery with or without spinal fusion. Subjects were Medicare recipients who underwent surgery in 1985, with 4 years of subsequent follow-up. There were 27,111 eligible patients, of whom 5.6% had fusions. Mean age was 72 years. Patients undergoing fusion had a complication rate 1.9 times greater than those who had surgery without fusion. The blood transfusion rate was 5.8 times greater, nursing home placement rate 2.2 times greater, and hospital charges 1.5 times higher (all P < 0.0005). Six-week mortality was 2.0 times greater for patients undergoing fusions (P = 0.025). Reoperation rates at 4 years were no lower for patients who had fusion surgery and results were similar in most diagnostic subgroups. Indications for fusion among older patients require better definition, preferably based on outcomes from prospective controlled studies.

*From the Departments of Medicine, Health Services, Family Medicine, §Neurological Surgery and Anesthesiology, and Orthopaedic Surgery, University of Washington; !!the Northwest Health Services Research and Development Field Program, Seattle Veterans Affairs Medical Center; and **the Center for Health Studies, Group Health Cooperative of Puget Sound.

Presented in part at the national meeting of the American Federation for Clinical Research, Seattle, WA, May 5, 1991, and at the Annual Meeting of the International Society for the Study of the Lumbar Spine, Chicago, May 22, 1992.

Supported by grant no. HS-06344 (the Back Pain Outcome Assessment Team) from the Agency for Health Care Policy & Research and by the Northwest Health Services Research and Development Field Program, Seattle VA Medical Center.

Accepted for publication February 1, 1993.

© Lippincott-Raven Publishers.