National trends in surgical procedures for degenerative cervical spine disease: 1990-2000

Abstract

Objective: Degenerative cervical spine disease is one of the most common indications for spinal surgical intervention. The impact of the unprecedented changes in healthcare technology and delivery over the past decade is unknown. We examined this issue using the Nationwide Inpatient Sample database, a representative sample of all United States inpatient hospitalizations.

Methods: All adult patients undergoing spinal procedures with a principal diagnosis of cervical spine disease were selected for analysis according to International Classification of Diseases 9th Revision clinical modification codes. Patients diagnosed with infection, neoplasia, fracture, or trauma, as well as those with noncervical or nonspecific principal diagnoses, were excluded.

Results: The total number of cervical spine procedures in the sampled population rose twofold, from 53,810 in 1990 to 112,400 in 2000. Anterior fusion procedures rose (17.8-69.5% of procedures), whereas nonfusion decompressions declined sharply (70.5-24.6%). Patient diversity increased with increasing rates of surgery among women (25.0-51.0 per 100,000) and minorities (18.4-45.7 per 100,000). Although average age (47.5-49.2 yr) and medical comorbidities (8.7-13.5% of patients) increased, mortality (0.21-0.14% of hospitalizations) and average length of stay (5.2-2.2 d) declined. Inflation-adjusted hospital charges rose by 48% to a total exceeding 2 billion dollars in 2000.

Conclusion: Compared with one decade ago, the surgical treatment of degenerative cervical spine disease has evolved to include a higher percentage of anterior and fusion procedures performed on a more diverse, older, and comorbid patient population, with shortened hospital stay and improved morbidity and mortality, although at substantially increased cost.