title: Epidemiologic and Economic Burden Attributable to First Spinal Fusion Surgery: Analysis From an Italian Administrative Database.
abstract: METHODS
  Retrospective large population based-study.
  
  
  OBJECTIVE
  Assessment of the epidemiologic trends and economic burden of first spinal fusions.
  
  
  BACKGROUND
  No adequate data are available regarding the epidemiology of spinal fusion surgery and its economic impact in Europe.
  
  
  METHODS
  The study population was identified through a data warehouse (DENALI), which matches clinical and economic data of different Healthcare Administrative databases of the Italian Lombardy Region. The study population consisted of all subjects, resident in Lombardy, who, during the period January 2001 to December 2010, underwent spinal fusion surgery (ICD-9-CM codes: 81.04, 81.05, 81.06, 81.07, and 81.08). The first procedure was used as the index event. We estimated the incidence of first spinal fusion surgery, the population and surgery characteristics and the healthcare costs from the National Health Service's perspective. The analysis was performed for the entire population and divided into the main groups of diagnosis.
  
  
  RESULTS
  The analysis identified 17,772 [mean age (SD): 54.6 (14.5) years, 55.3% females] spinal fusion surgeries. Almost 67% of the patients suffered from a lumbar degenerative disease. The incidence rate of interventions increased from 11.5 to 18.5 per 100,000 person-year between 2001 and 2006, and was above 20.0 per 100,000 person-year in the last 4 years. The patients' mean age increased during the observational time period from 48.1 to 55.9 years; whereas the median hospital length of stay reported for the index event decreased. The average cost of the spinal fusion surgery increased during the observational period, from &OV0556; 4726 up to &OV0556; 9388.
  
  
  CONCLUSIONS
  The study showed an increasing incidence of spinal fusion surgery and costs from 2001 to 2010. These results can be used to better understand the epidemiological and economic burden of these interventions, and help to optimize the resources available considering the different clinical approaches accessible today.
  
  
  METHODS
  4.
authors.affiliation: Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Cortesi
authors.affiliation: Neurosurgery Operative Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Assietti
authors.affiliation: Orthopedics and Traumatology Clinic, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Cuzzocrea
authors.affiliation: Orthopedic and Trauma I Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, Legnano Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Prestamburgo
authors.affiliation: Neurosurgery Unit, Fondazione I.R.C.C.S. "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pluderi
authors.affiliation: Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Cozzolino
authors.affiliation: Neurosurgery Operative Unit, Ospedale Fatebenefratelli e Oftalmico, ASST Fatebenefratelli Sacco, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Tito
authors.affiliation: Orthopedics and Traumatology Clinic, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vanelli
authors.affiliation: Orthopedic and Trauma I Unit, Ospedale Civile di Legnano, ASST Ovest Milanese, Legnano Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Cecconi
authors.affiliation: Neurosurgery Unit, Fondazione I.R.C.C.S. "Ca' Granda" Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Borsa
authors.affiliation: Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Cesana
authors.affiliation: Research Center on Public Health, University of Milan-Bicocca, Monza, Italy.
authors.forename: Lorenzo G
authors.initials: LG
authors.lastname: Mantovani
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000191:economics* / Q000706:statistics & numerical data*