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Cited by 1,041Spine and Intervertebral Disc PathologyMusculoskeletal pain and rehabilitationCervical and Thoracic Myelopathy

Spinal Fusion in the United States: Analysis of Trends From 1998 to 2008

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Rajaee, Sean S., Bae, Hyun W., Kanim, Linda E.A., Delamarter, Rick B.·2012·Spine
DOI 10.1097/brs.0b013e31820cccfb
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Abstract

STUDY DESIGN: Epidemiological study using national administrative data. OBJECTIVE: To provide a complete analysis of national trends in spinal fusion from 1998 to 2008 and compare with trends in laminectomy, hip replacement, knee arthroplasty, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft. SUMMARY OF BACKGROUND DATA: Previous studies have reported a rapid increase in volume of spinal fusions in the United States prior to 2001, but limited reports exist beyond this point, analyzing all spinal fusion procedures collectively. METHODS: Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 1998 to 2008. Discharges were identified using International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes for the following procedures: spinal fusion, laminectomy, hip replacement, knee arthroplasty, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft. Population-based utilization rates were calculated from the US census data. RESULTS: Between 1998 and 2008, the annual number of spinal fusion discharges increased 2.4-fold (137%) from 174,223 to 413,171 (P < 0.001). In contrast, during the same time period, laminectomy, hip replacement, knee arthroplasty, and percutaneous coronary angioplasty yielded relative increases of only 11.3%, 49.1%, 126.8%, and 38.8% in discharges, while coronary artery bypass graft experienced a decrease of 40.1%. Between 1998 and 2008, mean age for spinal fusion increased from 48.8 to 54.2 years (P < 0.001), in-hospital mortality rate decreased from 0.29% to 0.25% (P < 0.01), and mean total hospital charges associated with spinal fusion increased 3.3-fold (P < 0.001). The national bill for spinal fusion increased 7.9-fold (P < 0.001). CONCLUSION: Frequency, utilization, and hospital charges of spinal fusion have increased at a higher rate than other notable inpatient procedures, as seen in this study from 1998 to 2008. In addition, patient demographics and hospital characteristics changed significantly; in particular, whereas the average age for spinal fusion increased, the in-hospital mortality rate decreased.

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  • Despite rising intervention rates, functional disability from chronic low back pain has worsened in recent decades, and symptom prevalence and expenditures have also increased.

    “Despite rapidly increasing intervention, functional disability due to chronic low back pain (cLBP) has increased in recent decades.”

    From Report of the NIH Task Force on research standards for chronic low back pain. (2014) · cites this paper as [91]

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Authors
Rajaee, S. S., Bae, H. W., Kanim, L. E. A., & Delamarter, R. B.
Affiliations
  • Tufts University (US)
  • Cedars-Sinai Medical Center (US)
Corresponding author
  • Rajaee, Sean S.
  • Bae, Hyun W.
  • Kanim, Linda E.A.
  • Delamarter, Rick B.
ORCID
Venue
Spine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2012-01
Volume
37
Issue
1
Pages
67-76
ISSN
0362-2436 (ISSN-L)
DOI
10.1097/brs.0b013e31820cccfb
OpenAlex
W1994568570
Cited by
1,041
References
15
Citations by year
2026: 46 · 2025: 43 · 2024: 70 · 2023: 64 · 2022: 85 · 2021: 96 · 2020: 94 · 2019: 88 · 2018: 118 · 2017: 88 · 2016: 66 · 2015: 72 · 2014: 52 · 2013: 34 · 2012: 17
FWCI
24.68
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Spine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords
spinal fusion, surgical utilization trends, laminectomy, total hip arthroplasty, knee arthroplasty, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, hospital charges, in-hospital mortality, patient age, hospital characteristics, health care costs, National Inpatient Sample, administrative claims data
MeSH terms
Adolescent, Adult, Aged, Coronary Artery Bypass, Child, Child, Preschool, Female, Humans, Infant, Laminectomy, Length of Stay, Male, Middle Aged, Spinal Diseases, Spinal Fusion, United States, Angioplasty, Balloon, Coronary, Survival Rate, Hospital Mortality, Arthroplasty, Replacement, Young Adult

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