title: Increasing Rates of Surgical Management of Multilevel Spinal Curvature in Elderly Patients.
abstract: Retrospective analysis of Nationwide Inpatient Sample (NIS) database.
  
  
  
  To analyze trends in utilization and hospital charges for multilevel spinal curvature surgery in patients over 60 from 2004 to 2011.
  
  
  
  Multilevel spinal curvature has been increasingly recognized as a major source of morbidity in patients over sixty years of age. The economic burden of non-operative management for spinal curvature is elusive and likely underestimated. Though patient reported outcomes suggest that surgical treatment of spinal curvature may be superior to non-operative treatment in selected patients, surgical utilization trends remain unclear.
  
  
  
  Data were obtained from the NIS between 2004 and 2011. The NIS is the largest all-payer inpatient care database with approximately eight million annual patient discharges throughout the United States. Analysis included patients over age 60 with a spinal curvature diagnosis treated with a multi-level spinal fusion (≥3 levels fused) determined by ICD-9-CM diagnosis and procedure codes. Population-based utilization rates were calculated from US census data.
  
  
  
  A total of 84,302 adult patients underwent multilevel spinal curvature surgery from 2004 to 2011. The annual number of ≥3 level spinal curvature fusions in patients over age 60 increased from 6,571 to 16,526, representing a 107.8% increase from 13.4 cases per 100,000 people in 2004 to 27.9 in 2011 (p < .001). Utilization rates in patients 65-69 years old experienced the greatest growth, increasing by 122% from 15.8 cases per 100,000 people to 35.1. Average hospital charges increased 108% from $90,557 in 2007 to $188,727 in 2011 (p < .001).
  
  
  
  Rates of surgical management of multilevel spinal curvature increased from 2004 to 2011, exceeding growth of the 60+ age demographic during the same period. Growth was observed in all age demographics, and hospital charges consistently increased from 2004 to 2011 reflecting a per-user increase in expenditure.
  
  
  
  III.
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Sing
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL 60611, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Khanna
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Shaw
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA.
authors.forename: Lionel N
authors.initials: LN
authors.lastname: Metz
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA.
authors.forename: Shane
authors.initials: S
authors.lastname: Burch
authors.affiliation: Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens St. Box 3004, San Francisco, CA 94158, USA. Electronic address: bervenS@orthosurg.ucsf.edu.
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
mesh_terms: D000368:Aged; D005260:Female; D017722:Hospital Charges; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013121:Spinal Curvatures / Q000601:surgery*; D013123:Spinal Fusion / Q000191:economics / Q000706:statistics & numerical data*
keywords: Elderly; Epidemiology; Multilevel fusion; Scoliosis; Trends