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Current Trends in Demographics, Practice, and In-Hospital Outcomes in Cervical Spine Surgery: A National Database Analysis Between 2002 and 2011

Marquez-Lara, Alejandro MD; Nandyala, Sreeharsha V. BA; Fineberg, Steven J. MD; Singh, Kern MD

doi: 10.1097/BRS.0000000000000165

Study Design. Retrospective database analysis.

Objective. To investigate national trends of cervical spine surgical procedures from 2002 to 2011.

Summary of Background Data. There is a paucity of literature assessing the current practice trends and outcomes of cervical spine surgery following the 2008 Food and Drug Administration public health notifications regarding bone morphogenetic protein (BMP) utilization in cervical spine surgical procedures.

Methods. The National Inpatient Sample database was accessed for each year across 2002 to 2011. Patients undergoing anterior cervical fusion, posterior cervical fusion, and posterior cervical decompression were identified. Patient and hospitalization parameters including demographics, BMP utilization, costs, early postoperative outcomes, and mortality were assessed for each surgical cohort. A Pearson correlation coefficient with a 95% confidence interval (P < 0.05) was used to analyze trends in patient and hospital outcome parameters during this 10-year period.

Results. A total of 307,188 cervical spine procedures were performed from 2002 to 2011. Both the anterior cervical fusion and posterior cervical fusion cohort demonstrated a statistically significant increase in the number of procedures performed over time (r = +0.9, P < 0.001). A significant uptrend in patient age (r = +1.0, P < 0.001) and comorbidity burden (r = +0.9, P < 0.001) was demonstrated during the studied decade. Overall, BMP utilization (r = +0.7, P = 0.02) also demonstrated a significant increase during this time period, but demonstrated a decline after peaking in 2007. The posterior cervical fusion cohort demonstrated the greatest comorbidity, length of stay, costs, and mortality.

Conclusion. This study demonstrates that the number of cervical spine procedures has increased between 2002 and 2011, irrespective of the change in BMP utilization after the 2008 Food and Drug Administration warning. Despite an older patient population with greater comorbidities undergoing cervical spine surgeries, hospital length of stay and mortality has not significantly changed. However, we did note a significant increase in costs during this time period. These findings may be related to advances in surgical technology and instrumentation that may be associated with rising hospital costs.

Level of Evidence: N/A

In this analysis of the National Inpatient Sample database from 2002 to 2011, a significant increase in cervical spine cases was noted in an aging patient population with increasing comorbidities. Despite a lack of significant changes in the length of stay or mortality, total hospital costs increased during this period.

From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

Address correspondence and reprint requests to Kern Singh, MD, Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St, Ste 300, Chicago, IL 60612; E-mail:

Acknowledgment date: July 10, 2013. First revision date: October 23, 2013. Second revision date: November 27, 2013. Acceptance date: December 9, 2013.

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, royalties.

© 2014 by Lippincott Williams & Wilkins