Journal: Complex Fusion Operations Up in Older Americans

A report by The Journal of the American Medical Association has found that from 2002-2007 the rate of complex fusion surgery in older adults who are on Medicare increased 15-fold and hospital charges increased 40 percent.

The study concluded that during this time period there were more life-threatening complications with increasing surgical invasiveness, from 2.3 percent among patients having decompression alone to 5.6 percent among those undergoing complex fusions.

The document also revealed that 7.8 percent of patients with decompression were rehospitalized within 30 days, and 13 percent of those had a complex fusion. In addition, hospital charges increased 40 percent, taking into consideration inflation.

“It is unclear why more complex operations are increasing. It seems implausible that the number of patients with the most complex spinal pathology increased 15-fold in just six years. The introduction and marketing of new surgical devices and the influence of key opinion leaders may stimulate more invasive surgery, even in the absence of new indications. Surgeons may believe more aggressive intervention produces better outcomes,” the report said.

It also stated that improvements in surgical and anasthetic techniques as well as supportive care may make more invasive surgery a possibility when risks previously may have made the procedures impossible.

Another possible reason, according to the report, is financial incentives to hospitals and surgeons for more complex procedures.