title: National revision burden for lumbar total disc replacement in the United States: epidemiologic and economic perspectives.
abstract: METHODS
  Retrospective cohort study using a nationally representative inpatient database.
  
  
  OBJECTIVE
  To quantify the national revision burden for lumbar total disc replacements (TDRs) in the United States following Food and Drug Administration approval, for comparison with lumbar fusion and other common orthopedic procedures, including hip and knee replacement.
  
  
  BACKGROUND
  Previous studies of revision lumbar TDR surgery have been based on IDE studies. The epidemiology and costs of TDR revision surgery from a national perspective have not yet been reported.
  
  
  METHODS
  The Nationwide Inpatient Sample was used to identify primary and revision TDR and anterior fusion procedures in 2005 and 2006. Surgeries were identified in the Nationwide Inpatient Sample using ICD9-CM codes. The prevalence of TDR and fusion surgery was calculated as a function of age, gender, race, census region, primary payer class, and type of hospital. Average length of stay and total hospitalization costs were also computed for each type of procedure.
  
  
  RESULTS
  During the study period, there was a national total of 7172 TDR and 62,731 anterior fusion surgeries, including both primary and revisions. Overall, TDR patients were younger and had less comorbidity than fusion surgery patients. The average revision burden for lumbar TDR and anterior fusion was 11.2% and 5.8%, respectively. The average length of stay for primary lumbar TDR was significantly shorter compared to revision TDR, primary anterior fusion, and revision anterior fusion (P < 0.0001). Both the primary and the revision surgery using the TDR surgery involved significantly lower total hospital costs relative to anterior fusion surgery (P < 0.0001). Including revision, the average costs per TDR procedure were lower than anterior and posterior lumbar fusion.
  
  
  CONCLUSIONS
  Although the revision burden for TDR was significantly higher than fusion surgery, the TDR revision burden fell within the revision burden range of hip and knee replacement, which are generally considered successful and cost-effective procedures. Economically, the higher revision burden for TDRs was offset by lower costs for both the primary as well as the revision procedures relative to fusion.
authors.affiliation: From the *Exponent, Inc., Philadelphia, PA; †UCLA, Division of Neurosurgery, Los Angeles, CA; ‡Baton Rouge Orthopaedic Clinic, Baton Rouge, LA; and §Department of Orthopaedic Surgery, Thomas Jefferson University and Hospitals, Philadelphia, PA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kurtz
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Allyson
authors.initials: A
authors.lastname: Ianuzzi
authors.forename: Jordana
authors.initials: J
authors.lastname: Schmier
authors.forename: Lanman
authors.initials: L
authors.lastname: Todd
authors.forename: Jorge
authors.initials: J
authors.lastname: Isaza
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D055959:Intervertebral Disc Degeneration / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics; D059145:Total Disc Replacement / Q000191:economics*; D014481:United States / Q000453:epidemiology