Long-term health care utilisation and costs after spinal fusion in elderly patients

Abstract

Purpose: Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the long-term effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective.

Methods: 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59-88) at surgery were included. Average length of follow-up was 6.2 years (range 0.3-9.0 years). Data on resource utilisation and costs were obtained from national registers providing complete coverage of all reimbursed contacts with primary- and secondary health care providers. Data were available from 3 years prior fusion surgery until the end of 2009.

Results: Use of hospital-based health care increased in the year prior to and the first year following surgery. Hereafter it normalised to the level of the background population and was mainly composed of diseases unrelated to the spine. In contrast, the use of primary health care appeared to increase immediately after surgery and continued to increase to a level that significantly exceeded that of the background population. It could be demonstrated that the increase was mainly due to an increasing number of general practitioner consultations.

Conclusion: Spinal fusion surgery in older patients does not generate excess hospital-based health care use in the longer term as compared with the background population, but primary care use increases.

Fig. 1

Health care resource utilisation and costs prior to and after the spinal fusion procedure. Values are means with 95 % bias-corrected bootstrapped confidence intervals. N along the x-axis indicates number of patients completing follow-up for that respective year. Reference lines in cost graphs are average costs in the background population, with the upper limit representing the age group 75–84 years and the lower limit representing the age group 65–74 years (obtained from Sørensen and Søgaard [25])