Procedural, Reimbursement, and Geographic Trends in Adult Spinal Deformity Correction Surgery: A Medicare Analysis

This study aims to evaluate national trends in procedural volume, Medicare reimbursement rates, and geographic distribution of adult spinal deformity (ASD) correction surgeries among spine surgeons in the United States from 2013 to 2021.

Data was obtained from the Medicare Physician & Other Practitioners dataset, using Current Procedural Terminology (CPT) codes relevant to ASD surgeries. Median reimbursement rates were inflation-adjusted to 2021 dollars, with procedural volume and reimbursement trends assessed via univariate regression. Statistical significance was set at P < 0.05.

Among 111 unique spine surgeons, a total of 5,243 ASD correction procedures were identified. Surgeon participation increased by 29.63%, with neurosurgeons experiencing a rise of 55.56% (R² = 0.64, P = 0.009) and orthopaedic surgeons seeing a modest increase of 16.67% (R² = 0.06, P = 0.518). Procedure volume grew by 23.20%. The Midwest saw a 75.00% decrease in the number of surgeons, in stark contrast to the West, which experienced notable increases in both surgeon numbers (72.73%, P = 0.007) and procedure volumes (54.70%, P = 0.023). In terms of reimbursement, neurosurgeons saw a 37.57% rise in median reimbursement for certain procedures (R² = 0.51, P = 0.031), while orthopaedic surgeons observed a decrease in median reimbursement by 18.07% for the same procedures (R² = 0.69, P = 0.006), reflecting divergent financial outcomes across specialties.

This study highlights trends in the provision of ASD correction surgeries within the Medicare population, underscoring the importance of addressing regional disparities and ensuring access to surgical care for this growing patient demographic.