National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019

Abstract

Background Lumbar fusion (LF) is commonly performed to manage lumbar degenerative disc disease (LDDD) that has failed conservative measures. However, lumbar disc replacement (LDR) procedures are increasingly prevalent and designed to preserve motion in carefully selected patients. Methods A retrospective cohort study was performed using the National Inpatient Sample (NIS), queried from 2010 to 2019 to identify patients undergoing single and double-level LF or LDR with a diagnosis of LDDD using International Classification of Diseases (ICD) 9th (ICD-9) and 10th (ICD-10) revision diagnostic and procedure codes. Propensity score matching (PSM) with a ratio of 2:1 was performed. All cost estimates reflect reported hospital costs adjusted to December 2019 United States Dollars. Results A total of 1,129,121 LF cases (99.3%) and 8,049 LDR cases (0.7%) were identified, with 364,637 (32.3%) and 712 (8.8%) comprising two-level surgeries, respectively. 1,712 LDRs were performed in 2010 (1.27% of all), decreasing to 565 in 2013 (0.52%), and increased slightly to 870 in 2019 (0.74%). LDR patients were significantly more likely to be younger (mean age 41.2 vs. 57.1, P<0.001) and healthier (mean ECI 0.88 vs. 1.80, P<0.001). On matched analysis, LDR hospital costs were $4,529 less (P<0.001) and length of stay was 0.65 days shorter (P<0.001) than LF patients. LDR patients had lower rates of any complication (7.0% vs. 13.2%, P<0.001), neurologic complication (3.0% vs. 4.2%, P=0.006), and blood transfusion (3.1% vs. 8.1%, P<0.001) compared to LF patients. Conclusions The prevalence of LDR procedures decreased from 2010–2017 but began to increase again in 2018 and 2019. Single-level LDR was associated with reduced costs and length of stay (LOS), and lower rates of blood transfusion compared to LF in patients with LDDD.

Healthcare utilization trends in lumbar disc replacement: population-based administrative data

“…In the paper entitled “ National trends in the utilization of lumbar disc replacement for lumbar degenerative disc disease over a 10-year period, 2010 to 2019 ”, Upfill-Brown et al conducted a retrospective cohort study using population-based administrative data from the National Inpatient Sample in the United States ( 1 ). Authors aimed to determine national trends in lumbar disc replacement and lumbar fusion procedures and investigated the association between surgery type and hospitalization cost, length of stay, non-home discharge destination and complications during initial hospitalization after surgery.…”

“…Authors aimed to determine national trends in lumbar disc replacement and lumbar fusion procedures and investigated the association between surgery type and hospitalization cost, length of stay, non-home discharge destination and complications during initial hospitalization after surgery. They found that the frequency of lumbar disc replacement surgeries decreased between 2010–2013 and remained constant until a slight increase occurred in 2019 ( 1 ). Upfill-Brown et al also showed, after propensity score matching, lumber disc replacement patients had significantly lower complication rates, incurred fewer hospital costs and experienced a significantly shorter length of hospital stay than lumbar fusion patients ( 1 ).…”

“…They found that the frequency of lumbar disc replacement surgeries decreased between 2010–2013 and remained constant until a slight increase occurred in 2019 ( 1 ). Upfill-Brown et al also showed, after propensity score matching, lumber disc replacement patients had significantly lower complication rates, incurred fewer hospital costs and experienced a significantly shorter length of hospital stay than lumbar fusion patients ( 1 ).…”

“…We commend Upfill-Brown et al for obtaining a large, nationally representative sample of over 8,000 lumbar disc replacement patients. Authors accessed data which contain hospitalization information from over 40 states and cover more than 95% of the population ( 1 ). Use of administrative data offered a clear advantage over relying on clinical trial data in that real-world surgical trends were obtainable and generalizable.…”

“…Furthermore, the burden of patient complications occurring after surgery until initial hospital discharge may have been underestimated by Upfill-Brown et al We assume in-hospital complication rates were captured 3.51 [standard deviation (SD): 2.73] and 2.59 (SD: 1.84) days after surgery for fusion and disc replacement patients, respectively, based on mean hospital length of stay ( 1 ). However, this follow-up time may have been too brief; a previous observational study on lumbar fusion spinal surgery patients in the United States showed that complication rates rose from 14% immediately after surgery to almost 25% at 30 days post-operation, with the greatest increases in complication frequencies occurring between 10 and 20 days post-surgery ( 7 ).…”