Mitchell K Ng, Patrick P Nian, Jayson Saleet, Paul G Mastrokostas, Ariel N Rodriguez, Ameer Tabbaa, Jad Bou Monsef, Afshin E Razi
{"title":"Surgical Trends in Use of Lumbar Disk Arthroplasty Versus Lumbar Fusion From 2010 to 2021.","authors":"Mitchell K Ng, Patrick P Nian, Jayson Saleet, Paul G Mastrokostas, Ariel N Rodriguez, Ameer Tabbaa, Jad Bou Monsef, Afshin E Razi","doi":"10.5435/JAAOS-D-24-00571","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar disk arthroplasty (LDA) is a relatively novel procedure with limited indications and use in the United States, especially relative to lumbar fusion (LF). This study aimed to determine surgical trends between LDA versus LF over the past 10 years to quantify absolute/relative surgical volume over time and compare baseline patient demographics, readmission, 2-year revision rates, and costs-of-care.</p><p><strong>Methods: </strong>A total of 714,268 patients were identified from a nationwide database who underwent LF (n = 710,527) or LDA (n = 3,741) from 2010 to 2021. The percentage of patients managed by each surgical procedure was calculated overall and subdivided annually. Baseline demographics were compared between surgical groups, comparing postoperative readmission rates and 2-year revision rates. Linear regression modeling was done to evaluate trends/differences in procedural volume by year.</p><p><strong>Results: </strong>Beginning in 2010 to 2011, LDA constituted 1.0% of procedures, before the number/proportion of LDA procedures to LF has slowly dropped (1% in 2010 to 0.6% in 2021, P > 0.05). Patients undergoing LDA were younger (42.7 vs. 60.9 years, P < 0.0001) with a higher male proportion (50.9 vs. 42.8, P < 0.0001) and a lower Elixhauser Comorbidity Index (2.5 vs. 4.6, P < 0.0001). Patients undergoing LDA had lower rates of readmission (3.8 vs. 7.6%, P < 0.0001). Both LDA and LF average same-day reimbursements elevated sharply from 2010 to 2015 before decreasing to values lower than initially at 2010, with LF demonstrating a greater reduction in costs ($10,600 vs. $2,600, P < 0.05), although LDA remains cheaper ($2,900 vs. $5,300, P < 0.05).</p><p><strong>Conclusion: </strong>The surgical volume of LDA has remained steady while dropping in proportion relative to LF over the past decade. Although patients undergoing LDA are younger and have both fewer baseline demographic comorbidities and lower readmission rates, surgeons remain hesitant to perform this procedure over LF.</p><p><strong>Study design: </strong>Retrospective Cohort Study, Level III Evidence.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":"e1104-e1112"},"PeriodicalIF":2.8000,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5435/JAAOS-D-24-00571","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Lumbar disk arthroplasty (LDA) is a relatively novel procedure with limited indications and use in the United States, especially relative to lumbar fusion (LF). This study aimed to determine surgical trends between LDA versus LF over the past 10 years to quantify absolute/relative surgical volume over time and compare baseline patient demographics, readmission, 2-year revision rates, and costs-of-care.
Methods: A total of 714,268 patients were identified from a nationwide database who underwent LF (n = 710,527) or LDA (n = 3,741) from 2010 to 2021. The percentage of patients managed by each surgical procedure was calculated overall and subdivided annually. Baseline demographics were compared between surgical groups, comparing postoperative readmission rates and 2-year revision rates. Linear regression modeling was done to evaluate trends/differences in procedural volume by year.
Results: Beginning in 2010 to 2011, LDA constituted 1.0% of procedures, before the number/proportion of LDA procedures to LF has slowly dropped (1% in 2010 to 0.6% in 2021, P > 0.05). Patients undergoing LDA were younger (42.7 vs. 60.9 years, P < 0.0001) with a higher male proportion (50.9 vs. 42.8, P < 0.0001) and a lower Elixhauser Comorbidity Index (2.5 vs. 4.6, P < 0.0001). Patients undergoing LDA had lower rates of readmission (3.8 vs. 7.6%, P < 0.0001). Both LDA and LF average same-day reimbursements elevated sharply from 2010 to 2015 before decreasing to values lower than initially at 2010, with LF demonstrating a greater reduction in costs ($10,600 vs. $2,600, P < 0.05), although LDA remains cheaper ($2,900 vs. $5,300, P < 0.05).
Conclusion: The surgical volume of LDA has remained steady while dropping in proportion relative to LF over the past decade. Although patients undergoing LDA are younger and have both fewer baseline demographic comorbidities and lower readmission rates, surgeons remain hesitant to perform this procedure over LF.
Study design: Retrospective Cohort Study, Level III Evidence.
期刊介绍：
The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues.
Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.
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