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Spinal Fusion in the United States: Analysis of Trends From 1998 to 2008
Open accessAbstract
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 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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Metadata
- 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.
- Venue
- Spine
- Published
- 2012-01
- Volume
- 37
- Issue
- 1
- Pages
- 67-76
- ISSN
- 0362-2436 (ISSN-L)
- 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
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Spine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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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