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Linking American Spine Registry and Medicare Data: An Analysis of 8755 Lumbar Fusion Cases
Steven D Glassman1, Mladen Djurasovic2, Anthony L Asher3
1Norton Leatherman Spine Center, Louisville, KY.
Study Design:
Retrospective observational study.
Objective:
To evaluate whether the combined American Spine Registry and Medicare (ASR/CMS) data yield substantially different findings versus ASR data alone with regard to key parameters such as risk stratification, complication rates, and readmission rates in lumbar surgery investigated through an analysis of 8755 spondylolisthesis cases.
Summary Of Background Data:
Medicare data correlation has been effective for determining revision rates for other procedures, such as total hip replacement. Our aim is to determine whether these findings are translatable in the realm of lumbar spinal surgery investigated through an analysis of 8755 spondylolisthesis cases.
Materials And Methods:
The American Spine Registry (ASR) was queried for Medicare-eligible patients who underwent lumbar spinal fusion for lumbar spondylolisthesis. This cohort was analyzed based on ASR data alone in comparison to the same patients in the combined ASR/Medicare (ASR/CMS) data set. The primary outcome of interest was readmission at 30 and 90 days postoperatively.
Results:
There were 8755 Medicare-eligible cases with a diagnosis of spondylolisthesis within the ASR. The mean age was 72.7 years and 60.8% were female. Medical comorbidities were more frequently detected in the combined ASR/CMS data set, reflected by a higher mean Charlson Comorbidity Index score (3.49 vs. 3.27, P <0.001). Hospital readmission rates were significantly higher in the combined ASR/CMS data set at both 30 days (4.89% vs. 1.83%, P <0.001) and 90 days (7.68% vs. 2.66%, P <0.001), with notable increases in readmissions for infections and medical complications. Discharge disposition remained comparable across data sets, with most patients discharged to home or home health care.
Conclusion:
This study demonstrates that integrating patient-identified Medicare data with the ASR provides a more comprehensive assessment of outcomes for lumbar spinal fusion surgery as demonstrated through an analysis of 8755 spondylolisthesis cases. These findings, establish the importance of multisource data linkage to overcome the limitations of single-source registries, thereby enhancing data quality for clinical decision-making and quality improvement in spinal surgery.
