LUMBAR SPINAL-FUSION - A COHORT STUDY OF COMPLICATIONS, REOPERATIONS,AND RESOURCE USE IN THE MEDICARE POPULATION

Regional variations in lumbar spinal fusion rates suggest a poor conse nsus on surgical indications. Therefore, complications, costs, and reo peration rates were compared for elderly patients undergoing surgery w ith or without spinal fusion. Subjects were Medicare recipients who un derwent surgery in 1985, with 4 years of subsequent follow-up. There w ere 27,111 eligible patients, of whom 5.6% had fusions. Mean age was 7 2 years. Patients undergoing fusion had a complication rate 1.9 times greater than those who had surgery without fusion. The blood transfusi on rate was 5.8 times greater, nursing home placement rate 2.2 times g reater, and hospital charges 1.5 times higher (all P < 0.0005). Six-we ek mortality was 2.0 times greater for patients undergoing fusions (P = 0.025). Reoperation rates at 4 years were no lower for patients who had fusion surgery and results were similar in most diagnostic subgrou ps. Indications for fusion among older patients require better definit ion, preferably based on outcomes from prospective controlled studies.