title: Perioperative outcomes, complications, and costs associated with lumbar spinal fusion in older patients with spinal stenosis and spondylolisthesis.
abstract: OBJECTIVE
  The purpose of this study was to quantify the perioperative outcomes, complications, and costs associated with posterolateral spinal fusion (PSF) among Medicare enrollees with lumbar spinal stenosis (LSS) and/or spondylolisthesis by using a national Medicare claims database.
  
  
  METHODS
  A 5% systematic sample of Medicare claims data (2005-2009) was used to identify outcomes in patients who had undergone PSF for a diagnosis of LSS and/or spondylolisthesis. Patients eligible for study inclusion also required a minimum of 2 years of follow-up and a claim history of at least 12 months prior to surgery.
  
  
  RESULTS
  A final cohort of 1672 patients was eligible for analysis. Approximately half (50.7%) had LSS only, 10.2% had spondylolisthesis only, and 39.1% had both LSS and spondylolisthesis. The average age was 71.4 years, and the average length of stay was 4.6 days. At 3 months and 1 and 2 years postoperatively, the incidence of spine reoperation was 10.9%, 13.3%, and 16.9%, respectively, whereas readmissions for complications occurred in 11.1%, 17.5%, and 24.9% of cases, respectively. At 2 years postoperatively, 36.2% of patients had either undergone spine reoperation and/or received an epidural injection. The average Medicare payment was $36,230 ± $17,020, $46,840 ± $31,350, and $61,610 ± $46,580 at 3 months, 1 year, and 2 years after surgery, respectively.
  
  
  CONCLUSIONS
  The data showed that 1 in 6 elderly patients treated with PSF for LSS or spondylolisthesis underwent reoperation on the spine within 2 years of surgery, and nearly 1 in 4 patients was readmitted for a surgery-related complication. These data highlight several potential areas in which improvements may be made in the effective delivery and cost of surgical care for patients with spinal stenosis and spondylolisthesis.
authors.affiliation: Exponent, Inc., Philadelphia, Pennsylvania;
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Ong
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Auerbach
authors.forename: Edmund
authors.initials: E
authors.lastname: Lau
authors.forename: Jordana
authors.initials: J
authors.lastname: Schmier
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Ochoa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D006278:Medicare / Q000191:economics; D008875:Middle Aged; D019990:Perioperative Care / Q000191:economics*; D011183:Postoperative Complications / Q000175:diagnosis / Q000191:economics*; D013123:Spinal Fusion / Q000009:adverse effects / Q000191:economics*; D013130:Spinal Stenosis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D013168:Spondylolisthesis / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: CCI = Charlson Comorbidity Index; CPT = Current Procedural Terminology; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; LSS = lumbar spinal stenosis; PSF = posterolateral lumbar spinal fusion; lumbar spine; spine fusion; spondylolisthesis; stenosis