Marked Increase in Spinal Deformity Surgery Throughout the United States
Marked Increase in Spinal Deformity Surgery Throughout the United States
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DOI：
10.1097/brs.0000000000004041
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发表时间：
2021-10-15
期刊：
影响因子：
3
通讯作者：
Saifi, Comron
中科院分区：
文献类型：
--
作者：
Beschloss, Alexander;Dicindio, Christina;Saifi, Comron
研究设计.回顾性队列数据库研究。本研究的目的是调查脊柱畸形手术的利用率和人口统计学趋势。美国人口老龄化可能会导致成人退行性脊柱侧凸的发病率增加。随着国家对资源利用和基于价值的护理的关注，外科医生、研究人员和卫生保健政策制定者必须了解长融合结构脊柱手术的利用率和人口趋势。在国家住院患者样本（NIS）数据库中查询了2004年至2015年期间在44个州接受9个或更多椎骨融合或再融合（ICD-9-CM 81.64）的患者。人口统计学和经济学数据包括每年手术次数、发病率、患者年龄、性别、地区、保险类型、费用、常规出院、住院时间和数据。NIS数据库代表了美国医院20%的出院样本，不包括康复和长期急症护理医院，并对其进行加权以提供国家估计。结果。2014年，美国有14，615例融合涉及9个或更多椎骨。涉及9个或更多节段的融合数量从2004年的6072例增加了141%。2004年至2014年，65至84岁患者的长融合结构增加了460%。2015年，与长融合脊柱手术相关的平均住院费用为每例69，546美元。在2004年至2014年期间，接受脊柱畸形手术的个人支付者细分如下：54.2%的私人保险，18%的医疗保险和21.2%的医疗补助。长结构脊柱融合术的使用率大幅增加（141%）主要是由于65 - 84岁患者的手术发生率增加了460%。虽然原因不明，但这一增长可能至少部分是由平价医疗法案的实施、手术安全性的提高以及对脊柱骨盆参数的更好了解所推动的。
Study Design. Retrospective cohort database study.Objective. The aim of this study was to investigate trends in utilization and demographics in Spinal Deformity Surgery.Summary of Background Data. The aging population in the United States will likely result in increased incidence of adult degenerative scoliosis. With a national focus on resource utilization and value-based care, it is essential for surgeons, researchers, and health care policy makers to know utilization and demographic trends of spinal surgery with long fusion construct.Methods. The National Inpatient Sample (NIS) database was queried for patients who underwent fusion or refusion of nine or more vertebrae (ICD-9-CM 81.64) between 2004 and 2015 across 44 states. Demographic and economic data include annual number of surgeries, incidence, patient age, sex, region, insurance type, charge, routine discharge, length of stay, and data. The NIS database represents a 20% sample of discharges from US hospitals, excluding rehabilitation and long-term acute care hospitals, which is weighted to provide national estimates.Result. In 2014, there were 14,615 fusions involving nine or more vertebrae across the United States. The number of fusions involving nine or more levels has increased 141% from 6072 in 2004. Long fusion constructs increased 460% from 2004 to 2014 among patients 65 to 84 years' old. The mean hospital cost associated with long fusion spine surgery was $69,546 per case in 2015. Between 2004 and 2014, the payer breakdown for individuals receiving spinal deformity surgery is as follows: 54.2% private insurance, 18% Medicare, and 21.2% Medicaid.Conclusion. The massive increase (141%) in utilization of long construct spine fusion was primarily driven by 460% rise in incidence of the surgery among those aged 65 to 84. Although the cause is unknown, it is possible that this rise was, at least in part, driven by the implementation of the affordable care act, improved surgical safety, and better knowledge of spinopelvic parameters.