#164 Epidemiological Trends in Cervical Spine Surgery between 2002-2009

Oral Posters: Quality of Spine Care

Presented by: K. Singh


M. Pelton (1)
S.J. Fineberg (1)
M. Oglesby (1)
K. Singh (1)
A. Patel (2)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, USA
(2) Northwestern University Feinberg School of Medicine, Orthopaedic Surgery, Chicago, IL, USA


Introduction: Anterior cervical fusion, posterior cervical fusion and posterior cervical decompression are procedures routinely performed for cervical degenerative pathology. The purpose of this study was to analyze a population-based database to describe national trends of these three procedures in terms of incidence, demographics, co-morbidities, cost and mortality.

Methods: Data from the Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (the largest all-payer care database in the United States) was obtained for each year between 2002 and 2009. Patients undergoing anterior cervical fusion (ACF), posterior cervical fusion (PCF) and posterior cervical decompression (PCD) for the diagnosis of cervical radiculopathy and myelopathy were identified. Co-morbidities were calculated using a modified Charlson Comorbidity Index (CCI) score. Demographics (gender, age, and race), costs (adjusted for inflation; reported in 2009 currency values), and mortality associated with these complications were assessed in the three surgical subgroups. SPSS v.20 was used for statistical analysis using Independent-Samples T test for discrete variables and χ2 test for categorical data. Linear regression was performed to identify predictors of costs. A p-value of 0.001 was used to denote significance.

Results: An estimated 1,323,979 cervical spine surgeries were performed between 2002 and 2009 in the United States for the diagnosis of cervical myelopathy and/or radiculopathy. There was a statistically significant upward trend in the mean age of patients undergoing cervical spine surgery during this time period. ACF and PCF cohorts demonstrated statistically significant increases in co-morbidities and costs from 2002-2009. The PCF group had the greatest mortality, co-morbidities, costs, and longest hospitalizations compared to ACF and PCF cohorts across all time periods.

Discussion: Our study demonstrates that cervical spine surgeries have increased within the 8 year time duration between 2002-2009 (p=0.001). The primary increase in volume is due to the increasing number of anterior cervical fusions. Despite older patients with more co-morbidities undergoing ACF and PCF procedures, mortality has not changed. However, this patient population trended significant increases in costs during this time period. We hypothesize that these increased costs are due to an increased comorbidity burden in patients undergoing ACF or PCF. The results of this study can be used to set benchmarks for future epidemiological investigations in cervical spine surgery.

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