Marked Increase in Spinal Deformity Surgery Throughout the United States

Area of Science:

• Spine surgery
• Orthopedics
• Public health

Background:

• The aging US population is increasing the incidence of adult degenerative scoliosis.
• Understanding trends in spinal fusion surgery is crucial for resource allocation and value-based care.
• Long fusion constructs are a significant component of spinal deformity surgery.

Purpose of the Study:

• To investigate trends in the utilization and demographics of spinal deformity surgery.
• To analyze changes in patient populations undergoing spinal fusion procedures.
• To provide data for healthcare policy and surgical planning.

Main Methods:

• Retrospective cohort study using the National Inpatient Sample (NIS) database.
• Analysis of patients undergoing fusion or refusion of nine or more vertebrae (ICD-9-CM 81.64) from 2004 to 2015.
• Inclusion of demographic and economic data, including patient age, sex, insurance, and costs.

Main Results:

• A 141% increase in spinal fusions involving nine or more vertebrae from 2004 to 2014.
• A 460% increase in long fusion constructs among patients aged 65 to 84 years.
• Mean hospital cost was $69,546 per case in 2015, with private insurance as the primary payer (54.2%).

Conclusions:

• The significant rise in long construct spinal fusion is primarily attributed to increased incidence in older adults (65-84 years).
• Potential contributing factors include the Affordable Care Act, improved surgical techniques, and enhanced understanding of spinopelvic parameters.
• Further research is needed to fully understand the drivers of this utilization trend.