Complex Lower Back Surgery Increases Fifteenfold Among Medicare Patients
04/06/10 Portland, Ore.
Study co-authored by OHSU researcher finds spike in more invasive surgery has greater risk of life threatening complications without providing better results for older patients
There was a fifteenfold increase in the rate of complex lower back surgeries performed on older Americans from 2002 to 2007 that caused more life-threatening complications, according to a study published in the Journal of the American Medical Association co-authored by Richard A. Deyo, M.D., M.P.H., Kaiser Permanente Professor of Evidence-Based Family Medicine at Oregon Health & Science University.
This sharp rise in invasive operations nationwide caused more rehospitalizations, more expensive hospital stays and more deaths, researchers found. The surgeries were performed to treat lumbar spinal stenosis, the potentially painful degeneration of the lower spinal column that can decrease mobility and cause weakness in the legs.
The study, which appears in the April 7 issue of JAMA looked at patients 65 and older who are covered by Medicare. “The risks of spine surgery are particularly important for older patients,” Deyo explained.
The results call into question treatment trends. “Studies have found that less complex surgeries are generally as effective for treating problems in the lumbar region as the more invasive fusion procedure,” Deyo said. “But the rate of the less complex surgeries has declined while the number of more complicated surgeries has dramatically increased.”
There were 1.3 complex fusion procedures per 100,000 Medicare patients in 2000. It jumped to 19.9 operations per 100,000 Medicare patients in 2007. It is not clear why more complex operations are on the rise. The marketing of new surgical devices and financial incentives to hospitals may play a role in the trend, the study says.
In the end, “it may be prudent to consider whether other treatments, including less complicated operations, are a better tool for treating spinal stenosis,” Deyo said.
For more information or to read the study go to http://jama.ama-assn.org/cgi/content/full/303/13/1259?home.
This research was made possible with support from the Oregon Clinical and Translational Research Institute (OCTRI), grant number UL1 RR024140 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Funding also was provided by the National Institute of Arthritis, Musculoskeletal and Skin Diseases and the National Institute on Aging.
Oregon Health & Science University is the state’s only health and research university, and Oregon’s only academic health center. OHSU is Portland's largest employer and the fourth largest in Oregon (excluding government). OHSU's size contributes to its ability to provide many services and community support activities not found anywhere else in the state. It serves patients from every corner of the state, and is a conduit for learning for more than 3,400 students and trainees. OHSU is the source of more than 200 community outreach programs that bring health and education services to every county in the state.