Contact: Joe Martin
Harrisburg, PA - June 22, 2016 - Spinal fusion procedures performed in Pennsylvania hospitals increased 67.2% between 2004 and 2014 according to a new report released by the Pennsylvania Health Care Cost Containment Council (PHC4).
“Total payments from government payers Medicare and Medicaid amounted to $106 million based on 2013 estimates,” said Joe Martin, PHC4’s executive director. “When payments from private sector insurers and individuals are counted the total reaches a conservative $370 million for one year. As our population ages, especially in Pennsylvania, these figures raise considerable cost concerns for both the public and private sector going forward.”
There were 21,393 spinal fusions performed in Pennsylvania hospitals in 2014, up from 12,794 in 2004. Rates doubled for Pennsylvania residents age 65 and older and increased more than 60% for those age 45 to 64.
Included in the analysis are hospital-specific complication and readmission ratings for the 111 Pennsylvania hospitals that performed spinal fusion in 2014. Also reported are the number of cases for the 332 surgeons who performed these procedures.
Overall, 3.3% of patients experienced a surgical complication during the hospitalization in which the spinal fusion was performed, and 2.3% of patients were readmitted to the hospital for a surgical complication following their procedure. Surgical complications examined included mechanical complication or infection of device, implant, or graft; surgical site bleeding; or wound complication. About 5.4% of patients experienced an unplanned readmission following spinal fusion. Surgical complications were the most common reason for an unplanned readmission, followed by heart-related reasons (such as a heart attack or abnormal heartbeat), bloodstream infection, and blood clot in the lung.
Complications following spinal fusion often add to the overall cost of care through additional days spent in the hospital and increased payments. Patients who developed a complication while still in the hospital stayed, on average, 6.1 days—3.3 days longer than patients who did not develop a complication. When a patient was readmitted to the hospital for a complication following spinal fusion, the average length of stay for the readmission was 5.9 days. Overall, complications following spinal fusion added over 4,000 additional hospital days and an estimated $8.5 million in additional payments when compared to patients who did not experience a complication.
Increases in the number of spinal fusions on patients age 18-64 are noteworthy since surgical complications following these procedures can contribute to employment-related issues such as lost productivity and lost wages. Approximately 50% of in-hospital complications and 62% of readmissions for a complication occurred in patients age 18-64. Complications following spinal fusion for this age group alone added an estimated 2,180 additional hospital days and $4.5 million in payments (when compared to patients who did not experience a complication).
The report also looks at county-level population based utilization rates. Residents of Western PA had higher rates of spinal fusion than other areas of the state. Southeastern PA residents had the lowest rates. In describing this section of the report and regional variation, Martin added that, “Determining the appropriateness of spinal fusion procedures can be complicated and is often debated, especially since, for some patients, other less complex treatment may yield similar benefits.”
Spinal fusion per 10,000 residents
23.6 Western PA (up from 15.4 per 10,000 in 2004)
21.2 Central and Northeastern PA (up from 13.9 per 10,000 in 2004)
14.7 Southeastern PA (up from 8.3 per 10,000 in 2004)
PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in Pennsylvania. Copies of Spinal Fusions in Pennsylvania are free and available from PHC4’s website at http://www.phc4.org.