United States trends in lumbar fusion surgery for degenerative conditions
United States trends in lumbar fusion surgery for degenerative conditions
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DOI：
10.1097/01.brs.0000166503.37969.8a
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发表时间：
2005-06-15
期刊：
影响因子：
3
通讯作者：
Martin, BI
中科院分区：
文献类型：
--
作者：
Deyo, RA;Gray, DT;Martin, BI
研究设计.使用国家样本管理数据的回顾性队列研究。确定腰椎融合率在20世纪90年代是否增加，并将腰椎融合率与其他主要肌肉骨骼手术的腰椎融合率进行比较。以前的研究发现，腰椎融合率在20世纪80年代比其他类型的腰椎手术上升得更快。我们使用1988年至2001年的医疗保健成本和利用项目全国住院患者样本来研究趋势。联合S.人口普查数据用于计算年龄和性别调整的人口比率。我们排除了脊椎骨折、癌症或感染的患者。2001年，全国范围内因退行性疾病进行了超过122，000例腰椎融合术。这意味着每10万人中的融合率比1990年增加了220%。1996年融合器被批准后，这一增长速度加快。从1996年到2001年，腰椎融合术的数量增加了113%，而髋关节置换术和膝关节置换术的数量增加了13%到15%。腰椎融合率在60岁及以上的患者中上升最快。所有诊断中腰椎手术融合的比例增加。腰椎融合率在90年代比80年代上升得更快。最快速的增长是在新的外科植入物获得批准之后，并且远远大于其他主要骨科手术的增长。融合率增长最快的是60岁及以上的成年人。这些增加与澄清适应症或改善疗效的报告无关，表明需要更好的各种融合技术用于各种适应症的疗效数据。
Study Design. Retrospective cohort study using national sample administrative data.Objectives. To determine if lumbar fusion rates increased in the 1990s and to compare lumbar fusion rates with those of other major musculoskeletal procedures.Summary of Background Data. Previous studies found that lumbar fusion rates rose more rapidly during the 1980s than did other types of lumbar surgery.Methods. We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1988 through 2001 to examine trends. U. S. Census data were used for calculating age and sex-adjusted population-based rates. We excluded patients with vertebral fractures, cancer, or infection.Results. In 2001, over 122,000 lumbar fusions were performed nationwide for degenerative conditions. This represented a 220% increase from 1990 in fusions per 100,000. The increase accelerated after 1996, when fusion cages were approved. From 1996 to 2001, the number of lumbar fusions increased 113%, compared with 13 to 15% for hip replacement and knee arthroplasty. Rates of lumbar fusion rose most rapidly among patients aged 60 and above. The proportion of lumbar operations involving a fusion increased for all diagnoses.Conclusions. Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications.