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Hospital-Based Back Surgery: Geospatial-Temporal, Explanatory, and Predictive Models.

Lawrence Fulton1, Clemens Scott Kruse1

  • 1Department of Health Administration, Texas State University, San Marcos, United States.

Journal of Medical Internet Research
|October 31, 2019
PubMed
Summary
This summary is machine-generated.

Hospital-based back surgery increased 60% from 2012-2017, with obesity as a key driver. Planners must address rising demand and practice variations for this procedure.

Keywords:
back surgeryelastic netgeospatial mappinghealth economicslassoneurosurgeonobesitypractice variationrandom forestridge

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Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Public Health Policy

Background:

  • Hospital-based back surgery in the U.S. surged by 60% between 2012 and 2017.
  • The neurosurgeon supply remained constant during this period, while adult obesity rates increased by 5%.

Purpose of the Study:

  • To analyze the demand and costs of hospital-based back surgery by geographic location and over time.
  • To identify factors influencing back surgery demand, including provider practice variation, obesity, and socioeconomic indicators.

Main Methods:

  • Geospatial-temporal mapping of Current Procedural Terminology (CPT) codes for back surgery (63xxx).
  • Hierarchical time series modeling for demand forecasting at state, regional, and national levels.
  • Machine learning models (e.g., gradient-boosted random forests) to identify predictors of back surgery demand.

Main Results:

  • Significant, unexplained geographic and temporal variations in back surgery practice were observed.
  • Accurate demand forecasts indicated a 6.52% increase in 2018 and up to 13.00% by 2019, with an estimated $323.9 million increase in payments by 2019.
  • Obesity emerged as a primary factor driving the increased demand for hospital-based back surgery.

Conclusions:

  • Practice variation and rising obesity rates are critical factors in estimating future demand for back surgery.
  • Federal, state, and local health planners need to develop demand- and supply-side interventions to manage this growing healthcare challenge.