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Increased Proportion of Fusion Surgery for Degenerative Lumbar Spondylolisthesis and Changes in Reoperation Rate

A Nationwide Cohort Study With a Minimum 5-Year Follow-up

Kim, Chi Heon, MD, PhD∗,†,‡,§; Chung, Chun Kee, MD,PhD∗,†,‡,§,¶; Choi, Yunhee, PhD||; Kim, Min-Jung, MS||; Kim, Myo Jeong, MS∗∗; Shin, Sukyoun, PhD††; Yang, Seung Heon, MD∗,†,‡,§; Hwang, Sung Hwan, MD∗,†,‡,§; Kim, Dong Hwan, MD∗,†,‡,§; Park, Sung Bae, MD, PhD∗,‡‡; Lee, Jun Ho, MD, PhD§§

doi: 10.1097/BRS.0000000000002805
HEALTH SERVICES RESEARCH
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Study Design. A retrospective cohort study.

Objective. The objectives of the present study were to examine the changes in the number of surgeries, surgical methods selected, and reoperation rates between the years 2003 and 2008.

Summary of Background Data. The selection of the appropriate surgical method between decompression-only (D) and decompression plus fusion (DF) represents a challenging clinical dilemma in patients with degenerative lumbar spinal spondylolisthesis. DF is selected in greater than 90% of patients, mostly due to the associated low reoperation rate. However, the outcomes of D have been improved with minimally invasive decompression surgery techniques.

Methods. The Health Insurance Review and Assessment Service database was used to create cohorts of all Korean patients who underwent surgery for degenerative lumbar spinal spondylolisthesis in 2003 (2003 cohort, n = 5624) and 2008 (2008 cohort, n = 11,706). All patients were followed up for at least 5 years. Reoperation was defined as the occurrence of any type of second lumbar surgery during the follow-up period. The probabilities of reoperation were calculated using the Kaplan-Meier method.

Results. The number of surgeries increased 2.08-fold in 2008. Patients older than 60 years comprised 38.6% of the 2003 cohort and 52.4% of the 2008 cohort. The proportion of DF surgery was 31.13% in the 2003 cohort but 91.54% in the 2008 cohort. However, the high proportion of fusion surgery failed to reduce the reoperation probability in the 2008 cohort (8.1%) compared with that in the 2003 cohort (6.2%). The cost of DF was US$5264 and that of D was $2719 in 2008. DF decreased the reoperation probability by 1% at the cost of $421/patient in the 2008 cohort.

Conclusion. The increased proportion of fusion surgery without improvement in reoperation probability in an aging society may be cautiously addressed in deciding future health policies.

Level of Evidence: 4

Department of Neurosurgery, Seoul National University Hospital, Seoul, South Korea

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea

Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, South Korea

§Clinical Research Institute, Seoul National University Hospital, Seoul, South Korea

Department of Brain and Cognitive Sciences, Seoul National University, Seoul, South Korea

||Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea

∗∗Health Insurance Review and Assessment Research Institute, Health Insurance Review and Assessment Service, Wonju, South Korea

††Department of Customer Supporting Team, Samsung Life Insurance, Seoul, South Korea

‡‡Department of Neurosurgery, Seoul National University Boramae Hospital, Boramae Medical Center, Seoul, South Korea

§§Department of Neurosurgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, South Korea.

Address correspondence and reprint requests to Chun Kee Chung, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; E-mail: chungc@snu.ac.kr

Received 14 May, 2018

Revised 25 June, 2018

Accepted 9 July, 2018

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

A grant from the Korea Health Technology Research and Development Project supported this study through the Korea Health Industry Development Institute (KHIDI) funded by the Ministry of Health and Welfare, Republic of Korea (HC15C1320). Grant No. 0320160210 (2016-1062) from the Seoul National University Hospital also partially supported this study.

Relevant financial activities outside the submitted work: consultancy.

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