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

Rajaee, Sean S., MS*,†,‡; Bae, Hyun W., MD*,†; Kanim, Linda E.A., MA*,†; Delamarter, Rick B., MD*,†

doi: 10.1097/BRS.0b013e31820cccfb
Health Services Research

Study Design. Epidemiological study using national administrative data.

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

Summary of Background Data. Previous studies have reported a rapid increase in volume of spinal fusions in the United States prior to 2001, but limited reports exist beyond this point, analyzing all spinal fusion procedures collectively.

Methods. Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 1998 to 2008. 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. 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, during the same time period, 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.

This study provided an analysis of trends in patient- and health care system-related characteristics for spinal fusion in the United States between 1998 and 2008. For comparison, we reported on trends of laminectomy, hip replacement, knee arthroplasty, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft procedures.

*Spine Research Foundation, Santa Monica, CA;

Cedars-Sinai Spine Center Research Department, Los Angeles, CA;

Tufts University School of Medicine, Boston, MA (Rajaee and Bae are co-First Authors).

Address correspondence and reprint requests to Sean Shahriar Rajaee, MS, and Hyun W. Bae, MD, CO Research Department 444 South San Vicente Blvd, Suite 901, Los Angeles, CA 90048; E-mails: seanrajaee@gmail.com, baemd@me.com, and kaniml@cshs.org

Acknowledgment date: November 11, 2010. Acceptance date: December 22, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.