JAMA Study Demonstrates Higher Costs and Complications for Older Fusion Patients
BY LAUREN UZDIENSKI, APRIL 7, 2010
A study published in the Journal of the American Medical Association this week suggested higher rates of complications and higher costs for Medicare patients who undergo complex spinal fusions (defined as more than two disc levels or combined anterior and posterior approach) compared to decompression procedures. While the study confirmed questions about complications and resource use in elderly patients, it did not consider outcomes measures, such as improvement in function or reduction in pain.
The study reviewed CMS claims from 2002 through 2007 to observe that complex fusions in Medicare patients increased 15-fold during that time period. To evaluate frequency of surgical complications and costs for this population, the authors analyzed roughly 32,000 patients who underwent a spine procedure in 2007, with interventions ranging from decompression to simple fusion (one or two disc levels, single surgical approach) to complex fusion. Stenosis was the most common surgical indication in this population.
Among the results, the authors found:
- An increase in complications associated with surgical invasiveness, ranging from 2.3% in decompression patients to 5.6% in complex fusion cases.
- For complex fusion cases, the odds ratio of life-threatening complications compared to decompression alone was 2.95 (an odds ratio demonstrates the likelihood of an event in two groups; an OR of one indicates that an event is equally likely in both groups). This measure was adjusted for age, comorbidity, prior surgery and other factors.
- 13% of complex fusion patients were rehospitalized within 30 days, compared to 7.8% of decompression patients.
- Complex fusion procedures cost $80,888, on average, compared to $23,724 for decompression alone.
While the study determined that complex spinal fusion is more expensive than decompression, the absence of outcomes measures make it difficult to argue that the less-expensive decompression is necessarily cost-effective. For instance, is decompression more effective at relieving pain? Improving functional ability? With the increased emphasis on comparative effectiveness, we're likely to see an increase in head-to-head studies like this one, though more data is needed to fully weigh the benefits of fusion in elderly patients.
