Impact of the Economic Downturn on Elective Cervical Spine Surgery in the United States: A National Trend Analysis, 2003-2013.
OBJECTIVE
To analyze overall trends of elective cervical spine surgery in the United States from 2003 to 2013 with the goal of determining whether the economic downturn had an impact.


METHODS
Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification were used to identify elective cervical spine surgery procedures in the Nationwide Inpatient Sample from 2003 to 2013. National Health Expenditure, gross domestic product, and S&P 500 Index were used as measures of economic performance. The economic downturn was defined as 2008-2009. Confidence intervals were determined using subgroup analysis techniques. Linear regressions were completed to determine the association between surgery trends and economic conditions.


RESULTS
From 2003 to 2013, posterior cervical fusions saw a 102.7% increase. During the same time frame, there was a 7.4% and 14.7% decrease in the number of anterior cervical diskectomy and fusions (ACDFs) and posterior decompressions, respectively. The trend of elective cervical spine surgeries per 100,000 persons in the U.S. population may have been affected by the economic downturn from 2008 to 2009 (-0.03% growth). The percentage of procedures paid for by private insurance decreased from 2003 to 2013 for all ACDFs, posterior cervical fusions, and posterior decompressions. The linear regression coefficients (β) and R2values between the number of surgeries and each of the macroeconomic factors analyzed were not statistically significant.


CONCLUSIONS
The overall elective cervical spine surgery trend was not likely impacted by the economic downturn. Posterior cervical fusions grew significantly from 2003 to 2013, whereas ACDFs and posterior decompressions decreased.
Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA.
David N
DN
Bernstein
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA.
Amit
A
Jain
Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA.
David
D
Brodell
Department of Public Health Sciences, Division of Health Policy and Outcomes Research, University of Rochester Medical Center, Rochester, New York, USA.
Yue
Y
Li
Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA.
Paul T
PT
Rubery
Department of Orthopaedic Surgery, University of Rochester, Rochester, New York, USA; Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. Electronic address: Addisu_Mesfin@urmc.rochester.edu.
Addisu
A
Mesfin
D002574:Cervical Vertebrae / Q000601:surgery; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000191:economics / Q000379:methods / Q000639:trends; D005260:Female; D017048:Health Care Costs / Q000639:trends*; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D013122:Spinal Diseases / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D014481:United States / Q000453:epidemiology
Cervical spine surgery; Economic recession; Macroeconomic factors; National trends; Nationwide Inpatient Sample