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    Complex Spinal Surgeries Up Among Medicare Patients

    From 2002 to 2007, complex fusions rose 15-fold while overall spinal surgeries were down slightly

    TUESDAY, April 6 (HealthDay News) -- While the overall rate of spinal stenosis surgery among Medicare beneficiaries declined slightly during 2002 to 2007, the rate of complex fusions skyrocketed, and, compared with decompression, fusion was associated with higher risks of 30-day mortality and major complications in 2007, according to a study in the April 7 issue of the Journal of the American Medical Association.

    Richard A. Deyo, M.D., of Oregon Health and Science University in Portland, and colleagues performed a cohort analysis of Medicare claims to examine trends in lumbar spinal stenosis surgery for 2002 to 2007, and analyzed data on 32,152 patients who had the procedure during 2007. They grouped the patients into three gradations of surgery invasiveness: decompression only, simple fusion (one to two disk levels, single surgical approach), and complex fusion (more than two disk levels or combined anterior/posterior surgical approach).

    Overall, the researchers found that the adjusted surgical rate declined from 137.4 per 100,000 beneficiaries in 2002 to 135.5 per 100,000 beneficiaries in 2007. Meanwhile, the rate of complex fusion procedures increased from 1.3 to 19.9 per 100,000 beneficiaries, a 15-fold increase. After adjustment for age, comorbidity and previous spinal surgery, the odds ratio of life-threatening complications was 2.95 for complex fusion compared with decompression. Also, for complex fusion versus decompression only, 30-day mortality was 0.6 versus 0.3 percent, the mean hospital charge was $80,888 versus $23,724, and the 30-day rehospitalization rate was 13 versus 7.8 percent.

    "Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use," the authors write.

    A variety of financial disclosures were made including those with surgical products/medical equipment companies.

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