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Increasing Rates of Surgical Management of Multilevel Spinal Curvature in Elderly Patients

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Abstract

Study Design

Retrospective analysis of Nationwide Inpatient Sample (NIS) database.

Objective

To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011.

Summary of Background Data

Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear.

Methods

Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data.

Results

A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p <.001). Utilization rates in patients 65–69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001).

Conclusions

Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure.

Level of Evidence

III.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St., Box 3004, San Francisco, CA, 94158, USA

    David C. Sing BS, Jeremy D. Shaw MD, Lionel N. Metz MD, Shane Burch MD & Sigurd H. Berven MD

  2. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, USA

    Ryan Khanna BS

Authors
  1. David C. Sing BS
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  2. Ryan Khanna BS
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  3. Jeremy D. Shaw MD
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  4. Lionel N. Metz MD
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  5. Shane Burch MD
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  6. Sigurd H. Berven MD
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Corresponding author

Correspondence to Sigurd H. Berven MD.

Additional information

Author disclosures

DCS (none); RK (none); JDS (none); LNM (none); SB (personal fees from Consulting, grants from Spine Fellowship Grant: AO Spine, Globus, Nuvasive, outside the submitted work); SHB (personal fees from board membership: Globus Medical, Medtronic, Stryker; personal fees from consultancy: Medtronic, Stryker; grants from AO Spine, NIH, NSF, Globus Medical; personal fees from lectures: Stryker, Globus, Medtronic, RTI; personal fees from royalties: Medtronic; personal fees from stock/stock options: Simpirica Spine, Providence Medical, outside the submitted work).

This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number TL1 TR000144. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

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Sing, D.C., Khanna, R., Shaw, J.D. et al. Increasing Rates of Surgical Management of Multilevel Spinal Curvature in Elderly Patients. Spine Deform 4, 365–372 (2016). https://doi.org/10.1016/j.jspd.2016.03.005

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  • DOI: https://doi.org/10.1016/j.jspd.2016.03.005

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