TY - JOUR
T1 - Impact of the Economic Downturn on Elective Cervical Spine Surgery in the United States
T2 - A National Trend Analysis, 2003–2013
AU - Bernstein, David N.
AU - Jain, Amit
AU - Brodell, David
AU - Li, Yue
AU - Rubery, Paul T.
AU - Mesfin, Addisu
N1 - Funding Information:
The Healthcare Cost and Utilization Project (HCUP), through a federal-state-industry partnership sponsored by the Agency for Healthcare Research and Quality, publishes the Nationwide Inpatient Sample (NIS). 16 Each year of NIS data contains approximately 20% of all discharges from U.S. hospitals, which makes the NIS the largest nationally representative all-payer health care database in the United States. A trend weight file available on the HCUP website allows for the 20% sample to be extrapolated to full population estimates. The Agency for Healthcare Research and Quality suggests that longitudinal analyses, such as our study period from 2003 to 2013, are appropriate with NIS data.
Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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 R2 values 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.
AB - 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 R2 values 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.
KW - Cervical spine surgery
KW - Economic recession
KW - Macroeconomic factors
KW - National trends
KW - Nationwide Inpatient Sample
UR - http://www.scopus.com/inward/record.url?scp=84993977998&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84993977998&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2016.09.058
DO - 10.1016/j.wneu.2016.09.058
M3 - Article
C2 - 27667575
AN - SCOPUS:84993977998
SN - 1878-8750
VL - 96
SP - 538
EP - 544
JO - World neurosurgery
JF - World neurosurgery
ER -