Change in rates of primary atlantoaxial spinal fusion surgeries in the United States (1993–2015)

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The objective of this study was to investigate revision burden and associated demographic and economic data for atlantoaxial (AA) fusion procedures in the US.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patient data from the National Inpatient Sample (NIS) database for primary AA fusion were obtained from 1993 to 2015, and for revision AA fusion from 2006 to 2014 using ICD-9 procedure codes. Data from 2006 to 2014 were used in comparisons between primary and revision surgeries. National procedure rates, hospital costs/charges, length of stay (LOS), routine discharge, and mortality rates were investigated.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Between 1993 and 2014, 52,011 patients underwent primary AA fusion. Over this period, there was a 111% increase in annual number of primary surgeries performed. An estimated 1372 patients underwent revision AA fusion between 2006 and 2014, and over this time period there was a 6% decrease in the number of revisions performed annually. The 65–84 year-old age group increased as a proportion of primary AA fusions in the US from 35.9% of all AA fusions in 1997 to 44.2% in 2015, an increase of 23%. The mean hospital cost for primary AA surgery increased 32% between 2006 and 2015, while the mean cost for revision AA surgery increased by 35% between 2006 and 2014. Between 2006 and 2014, the mean hospital charge for primary AA surgery increased by 67%; the mean charge for revision surgery over that same period increased by 57%. Between 2006 and 2014, the mean age for primary AA fusions was 60 years, while the mean age for revision AA fusions was 52 years. The mean LOS for both procedures decreased over the study period, with primary AA fusion decreasing by 31% and revision AA fusion decreasing by 24%. Revision burden decreased by 21% between 2006 and 2014 (mean 4.9%, range 3.2%–6.4%). The inpatient mortality rate for primary AA surgery decreased from 5.3% in 1993 to 2.2% in 2014.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The number of primary AA fusions between 2006 and 2014 increased 22%, while the number of revision procedures has decreased 6% over the same period. The revision burden decreased by 21%. The inpatient mortality rate decreased 62% (1993–2014) to 2.2%. The increased primary fusion rate, decreased revision burden, and decreased inpatient mortality determined in this study may suggest an improvement in the safety and success of primary AA fusion.</jats:p></jats:sec>

Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…Given the presence of coding inaccuracies as well as the potential for data transfer errors or exclusions in large database studies, this potential source of error cannot be overlooked. 30 Given the utilization of a less familiar coding system for procedure codes, this may have an additional effect on coding accuracy.…”

Intrafacet Spacer Placement as a Mobility-Sparing Bailout Option in Atlantoaxial Fusion Construct Salvage

“…Instrumented arthrodesis has become a mainstay of contemporary spinal surgery and a focus for optimization and advancement. [1][2][3][4][5][6][7][8][9][10] Treatment around the atlantoaxial (AA) joint complex of the craniovertebral junction (CVJ) is particularly challenging given regional pathology, biomechanics, and anatomy. 11 Posterior segmental instrumented fusion, historically consisting of bilateral posterolateral screw and rod constructs, demands advanced consideration in the setting of revision procedures because successful arthrodesis can prevent occipitocervical fixation and the associated impacts on quality of life.…”

“…11 Posterior segmental instrumented fusion, historically consisting of bilateral posterolateral screw and rod constructs, demands advanced consideration in the setting of revision procedures because successful arthrodesis can prevent occipitocervical fixation and the associated impacts on quality of life. [10][11][12][13][14] We present a case of successful revision of failed AA posterior segmental instrumented fusion constructs using adjunct bilateral AA intrafacet spacers.…”

Pelvic Fixation With a Quad-Rod Technique Using S2 Alar Iliac and Medialized Entry Iliac Screws for Long Fusion Constructs

“…In addition, given the increasing amount of healthcare expenditure on ASD, minimizing rates of revision surgery would improve cost-effectiveness, which has become an increasing concern among insurers and policy makers. 5 In 2006, the senior author published a novel method on using a four-rod technique for thoracolumbar reconstruction based on alternating between the Roy Camille screw trajectory (straight in) and Magerl screw trajectory (converging lateral to medial) at each level in the lumbar spine. 6,7 This was followed by insertion of two iliac screws bilaterally and four rods.…”

“…In addition, given the increasing amount of healthcare expenditure on ASD, minimizing rates of revision surgery would improve cost-effectiveness, which has become an increasing concern among insurers and policy makers. 5 …”