AN ASSESSMENT OF SURGERY FOR SPINAL STENOSIS - TIME TRENDS, GEOGRAPHIC VARIATIONS, COMPLICATIONS, AND REOPERATIONS

OBJECTIVE: To study temporal trends and geographic variations in the u se of surgery for spinal stenosis, estimate short-term morbidity and m ortality of the procedure, and examine the likelihood of repeat back s urgery after surgical repair. DESIGN: Cohort study based on Medicare c laims. SETTING: Hospital care. SUBJECTS: All Medicare beneficiaries 65 years of age or older who received a lumbar spine operation for spina l stenosis in 1985 or 1989 were followed through 1991 (10,260 patients from the 1985 cohort and 18,655 from the 1989 cohort).MAIN OUTCOME ME ASURES: Two outcomes were measured: (1) rates of operation for spinal stenosis by state and (2) on an individual level, operative complicati ons (cardiopulmonary, vascular, or infectious), postoperative mortalit y, and time between first operation and any subsequent reoperation. RE SULTS: Rates of surgery for spinal stenosis increased eightfold from 1 979 to 1992 for patients aged 65 and older and varied almost fivefold among US states. Mortality and operative complications increased with age and comorbidity. Complications were more likely for men and for in dividuals receiving spinal fusions. The 1989 cohort experienced a slig htly higher probability of reoperation than the 1985 cohort for the fi rst 3 years of follow-up. CONCLUSIONS: A rapid increase in surgery rat es for spinal stenosis was identified over a 14-year period. The wide geographic variations and substantial complication rate from this elec tive surgical procedure (partly related to patient age) suggest a need for more information on the relative efficacy of surgical and nonsurg ical treatments for this condition. The risks and benefits of particul ar surgical procedures for specific clinical and demographic subgroups as well as individual patient preferences regarding surgical risks an d possible outcomes should also be evaluated further. These issues are likely to become increasingly important with the aging of the US popu lation.