Inflation-adjusted inpatient hospital costs for lumbar fusion in the United States increased from $3.86 billion in 2002 to $14.1 billion in 2023 as multilevel and combined anterior-posterior fusion procedures became more common during the study period, according to a national cross-sectional analysis of more than 5 million admissions.
In the study, investigators analyzed over 5 million lumbar fusion admissions from 2002 to 2023 using nationally representative hospital discharge data. In 2023, there were 274,750 procedures among patients with a mean age of about 63 years, 52% of whom identified as female.
The age-adjusted rate of inpatient lumbar fusion increased from 60.1 procedures per 100,000 US residents in 2002 to a peak of 89.9 per 100,000 individuals in 2016 before declining to 80 per 100,000 individuals by 2023. Lumbar fusion procedures performed in hospital-owned outpatient facilities also increased during the study period, rising from 2.1% of all fusions in 2016 to 9.8% in 2022.
During the study period, procedural complexity increased. Combined anterior–posterior fusions increased from 19.6% of procedures in 2016 to 41.1% in 2023, while multilevel fusions increased from 44.8% to 50.1%. In contrast, single-level single-column fusion procedures declined from 43.7% to 25.1%.
Costs increased in parallel. From 2002 to 2023, inflation-adjusted annual inpatient hospital costs rose from $3.86 billion to $14.1 billion and mean per-procedure inpatient costs increased from $25,849 to $45,458.
Procedure costs varied by surgical complexity. In 2023, the mean inpatient cost was $33,610 for one-level single-column fusion compared with $55,034 for multilevel AP fusion.
Surgical indications also shifted. From 2002 to 2023, fusion rates increased for scoliosis (271.2%), spinal stenosis (218%), and spondylolisthesis (83.4%), while procedures for disc degeneration and disc herniation declined by more than 80%.
The investigators noted that administrative data lack clinical detail such as the severity of pain, functional outcomes, or neurologic symptoms, limiting assessment of procedure appropriateness or comparative effectiveness.
“The clinical advantages of multilevel and AP fusion procedures need to be further investigated, specifically examining readmission, complications, and [patient-reported outcomes],” wrote lead study author Brook I. Martin, PhD, MPH, of the Department of Orthopaedics at the University of Utah, and colleagues.
Full disclosures can be found in the study.
Source: JAMA Network Open
