To analyze trends in lumbar fusion procedures, costs, and indications in the United States from 2002 to 2023, highlighting their clinical significance.
Key Findings:
Inflation-adjusted inpatient hospital costs for lumbar fusion increased from $3.86 billion in 2002 to $14.1 billion in 2023.
The age-adjusted rate of inpatient lumbar fusion peaked at 89.9 per 100,000 individuals in 2016, then declined to 80 per 100,000 by 2023.
Combined anterior-posterior fusions rose from 19.6% in 2016 to 41.1% in 2023, while single-level single-column fusions decreased from 43.7% to 25.1%.
Mean per-procedure inpatient costs increased from $25,849 to $45,458 from 2002 to 2023.
Fusion rates increased for scoliosis (271.2%), spinal stenosis (218%), and spondylolisthesis (83.4%), while rates for disc degeneration and herniation declined by over 80%.
Lumbar fusion procedures performed in hospital-owned outpatient facilities increased from 2.1% in 2016 to 9.8% in 2022.
Interpretation:
The increase in costs and complexity of lumbar fusion procedures highlights a shift in surgical practices and indications, necessitating further investigation into clinical outcomes and their implications.
Limitations:
Administrative data lacks clinical detail such as severity of pain, functional outcomes, or neurologic symptoms, limiting assessment of procedure appropriateness or comparative effectiveness.
The lack of clinical detail may impact the interpretation of the findings.
Conclusion:
Further research is needed to evaluate the clinical advantages of multilevel and anterior-posterior fusion procedures, particularly regarding readmission rates, complications, and patient-reported outcomes, emphasizing the need for comprehensive data.
Systematic review found robotic-assisted total hip arthroplasty improved implant positioning precision without demonstrating better patient-reported outcomes or lower complication rates than conventional surgery.
Older patients with documented cognitive impairment also experienced greater postoperative functional decline following elective total knee arthroplasty
