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Cost and Utilization Trends of Lumbar Fusion
Brook I Martin1, Sohail K Mirza2,3, Brian A Karamian1
1Department of Orthopaedics, University of Utah, Salt Lake City.
JAMA Network Open
|March 4, 2026
Summary
Lumbar fusion utilization and costs significantly increased from 2002 to 2023, with a shift towards more complex multilevel and anterior-posterior column procedures. Outpatient use also grew, alongside rising national and per-procedure expenses.
Area of Science:
- Health Economics and Outcomes Research
- Spine Surgery Trends
- Medical Procedure Utilization
Background:
- The cost of lumbar fusion surgery has risen, prompting consideration of payment reforms like Medicare price limits.
- Understanding trends in lumbar fusion utilization, cost, and case-mix is crucial for healthcare policy and resource allocation.
Purpose of the Study:
- To analyze trends in the cost, utilization, and procedural case-mix of lumbar fusion in the United States from 2002 to 2023.
- To provide insights into the evolving landscape of lumbar fusion surgery and its economic implications.
Main Methods:
- A cross-sectional analysis utilizing survey-weighted data from the National Inpatient Sample (NIS) and Nationwide Ambulatory Surgical Sample (NASS) from 2002 to 2023.
- Inclusion criteria encompassed US adults aged 20 years and older undergoing any type of lumbar fusion.
- Key outcomes measured included total procedures, patient demographics, inflation-adjusted costs, and procedure rates per 100,000 population.
Main Results:
- Total lumbar fusion admissions increased, with a shift towards more complex multilevel and combined anterior-posterior column fusions.
- The age-adjusted population rate of inpatient fusion procedures peaked in 2016 before a slight decline by 2023.
- Lumbar fusion procedures in hospital-owned outpatient facilities saw a notable increase.
- Inflation-adjusted hospital costs for lumbar fusion surged by 265.3% between 2002 and 2023, with a significant rise in mean per-procedure costs.
- The average cost of fusion procedures increased substantially, particularly for multilevel anterior-posterior column fusions.
Conclusions:
- Lumbar fusion trends demonstrate increased overall utilization, a shift to more complex surgical approaches, and expanded use in outpatient settings.
- Both national and per-procedure costs for lumbar fusion have escalated significantly over the study period.
- These findings highlight the need for continued monitoring and potential policy interventions regarding lumbar fusion procedures and costs.
