Journal ArticleDOI
An Assessment of Surgery for Spinal Stenosis: Time Trends, Geographic Variations, Complications, and Reoperations
TLDR
To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short‐term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.Abstract:
OBJECTIVE: To study temporal trends and geographic variations in the use of surgery for spinal stenosis, estimate short-term morbidity and mortality of the procedure, and examine the likelihood of repeat back surgery after surgical repair.
DESIGN: Cohort study based on Medicare claims.
SETTING: Hospital care.
SUBJECTS: All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spinal stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort).
MAIN OUTCOME MEASURES: Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complications (cardiopulmonary, vascular, or infectious), postoperative mortality, and time between first operation and any subsequent reoperation.
RESULTS: Rates of surgery for spinal stenosis increased eightfold from 1979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for individuals receiving spinal fusions. The 1989 cohort experienced a slightly higher probability of reoperation than the 1985 cohort for the first 3 years of follow-up.
CONCLUSIONS: A rapid increase in surgery rates for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elective surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurgical treatments for this condition. The risks and benefits of particular surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks and possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US population. J Am Geriatr Soc 44:285–290, 1996.read more
Citations
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Journal ArticleDOI
The rising prevalence of chronic low back pain.
Janet K. Freburger,George M. Holmes,Robert P. Agans,Anne Jackman,Jane D. Darter,Andrea S. Wallace,Liana D. Castel,William D. Kalsbeek,Timothy S. Carey +8 more
TL;DR: The prevalence of chronic, impairing LBP has risen significantly in North Carolina, with continuing high levels of disability and health care use, and a substantial portion of the rise in LBP care costs over the past 2 decades may be related to this rising prevalence.
Journal ArticleDOI
Trends, Major Medical Complications, and Charges Associated with Surgery for Lumbar Spinal Stenosis in Older Adults
Richard A. Deyo,Sohail K. Mirza,Brook I. Martin,William Kreuter,David C. Goodman,Jeffrey G. Jarvik +5 more
TL;DR: Examining trends in use of different types of stenosis operations and the association of complications and resource use with surgical complexity found that in 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resourceUse.
Journal ArticleDOI
Surgical versus Nonsurgical Therapy for Lumbar Spinal Stenosis
James Neil Weinstein,Tor D. Tosteson,Jon D. Lurie,Anna N. A. Tosteson,Emily A. Blood,Brett Hanscom,Harry N. Herkowitz,Frank P. Cammisa,Todd J. Albert,Scott D. Boden,Alan S. Hilibrand,Harley Goldberg,Sigurd Berven,Howard S. An +13 more
TL;DR: Patients who underwent surgery showed significantly more improvement in all primary outcomes than did patients who were treated nonsurgically, and the combined as-treated analysis showed a significant advantage for surgery by 3 months for allPrimary outcomes.
Journal ArticleDOI
United States trends in lumbar fusion surgery for degenerative conditions
Richard A. Deyo,Darryl T. Gray,Darryl T. Gray,William Kreuter,Sohail K. Mirza,Brook I. Martin +5 more
TL;DR: Lumbar fusion rates rose even more rapidly in the 90s than in the 80s, and the most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures.
Journal ArticleDOI
Spinal fusion in the United States: analysis of trends from 1998 to 2008.
TL;DR: 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.
References
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A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation☆
TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
Journal ArticleDOI
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
TL;DR: It is concluded that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
Journal ArticleDOI
Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature.
TL;DR: A meta-analysis was undertaken to determine the effects of surgery for lumbar spinal stenosis on pain and disability, and few patient characteristics were found to predict outcome.
Journal ArticleDOI
Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure.
TL;DR: Complications, length of hospitalization, and charges were higher for patients who had had a spinal arthrodesis than for those who had not, and operations for conditions other than a herniated disc were associated with more complications and greater use of resources than were operations for removal of a hernia.
Journal ArticleDOI
An Assessment of Radical Prostatectomy: Time Trends, Geographic Variation, and Outcomes
Grace L. Lu-Yao,Dale McLerran,John H. Wasson,John E. Wennberg,John H. Wasson,Thomas A. Bubolz,Catherine C. Lindsay,Benjamin Littenberg,Ann Barry Flood,Chiang-Hua Chang,Albert G. Mulley,Michael J. Barry,Christopher M. Coley,Floyd J. Fowler,Reginald C. Bruskewitz,Peter C. Albertson,Craig Fleming +16 more
TL;DR: The sharp increase and wide geographic variation in radical prostatectomy rates make the evaluation of this surgical procedure a pressing issue and the rising rate of radical prostateCTomy among men aged 75 years and older merits special attention.