Complex spinal surgery jumps in U.S. elderly: study
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Older patients with lower back pain are increasingly getting more complex and costlier spinal fusion surgeries, resulting in higher rates of life-threatening complications and increasing costs for the healthcare system, U.S. researchers said on Tuesday.
A study of records from the federal Medicare program for the elderly and disabled between 2002 and 2007 revealed a 15-fold increase in the rate of complex surgeries to treat spinal stenosis - a common condition in the elderly in which the spinal canal narrows, causing pain in the back and legs.
And while the number of overall procedures to treat this problem dipped during the period, hospital charges for those surgeries rose by 40 percent on an inflation-adjusted basis, Dr. Richard Deyo of the Oregon Health and Science University in Portland and his colleagues reported in the Journal of the American Medical Association.
In a telephone interview Deyo said the trend in part is related to the introduction of new technology, such as spinal cages and special screws used to fuse vertebrae together.
But it also reflects savvy marketing by orthopedic device makers such as Stryker Corp., Medtronic Inc. and Johnson & Johnson’s DePuy unit, that has convinced surgeons more complex surgery is better, Deyo said.
Studies, however, suggest complex spinal fusion surgeries offer little benefit over simpler procedures for most patients, and increase the risk of complications.
“It is driving up the cost of care without much evidence that it is improving care,” Deyo said.
A study last year published in JAMA found that the cost of treating spine problems in the United States rose 65 percent in the past decade to $85.9 billion a year, rivaling the economic burden of treating cancer, which costs $89 billion.
Yet, for all of the spending, they found people with spine problems actually felt worse.
Deyo’s team studied three specific surgical procedures for lumbar stenosis: decompression, in which part of the vertebrae is removed to ease pressure on nerve roots; simple fusion, in which one or two discs are fused together through an incision in the back or abdomen; and complex fusion, in which more than 3 vertebrae are treated or the surgery is done from both the back and front.
Overall, the procedure rate fell 1.4 percent during the study period, but rates of complex fusion surgery increased from 1.3 per 100,000 patients to 19.9 per 100,000.
“What happened was the most complex type of surgery increased 15-fold over that period of time, a far more rapid increase than we could explain just on the basis of more severe disease,” Deyo said.
“What we also found is these more complex operations are associated with a higher rate of serious complications.”
Patients in the study who had a complex fusion procedure had a nearly three times higher odds of a life-threatening complication compared with those who only got decompression.
And overall hospital charges rose 40 percent in inflation-adjusted dollars, the team found.
Dr. Eugene Carragee of the Stanford University School of Medicine in California said in a commentary that the study should remind patients, doctors and insurance companies to carefully weigh the options for spinal surgery.
The efficacy of basic spinal techniques “must be assessed carefully against the plethora of unproven but financially attractive alternatives,” Carragee wrote, noting that “financial incentives and market forces do not favor this careful assessment before technologies are widely adopted.”
SOURCE: Journal of the American Medical Association, April 7, 2010.
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