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2013년 11월 25일 월요일

Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the medicare population

Brief review



*Title: Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the medicare population.

*Author: Richard A. Deyo, Brook I. Martin, Alex Ching, Anna N. A. Tosteson, Jeffrey G. Jarvik, William Kreuter, Sohail K. Mirza.




STUDY DESIGN
Retrospective cohort analysis of Medicare claims for 2006-2009.


OBJECTIVE
To examine whether interspinous distraction procedures are 1)used selectively in patients with more advanced age or comorbidity.
2)associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery.


SUMMARY OF BACKGROUND DATA
There are few population-based data evaluating patterns of interspinous spacer surgery and nonsurgical care.


METHODS
Medicare inpatient claims data divided into 4 groups. (with stenosis undergoing surgery, n = 99,084)
(1) interspinous process spacer alone
(2) laminectomy and a spacer
(3) decompression alone
(4) lumbar fusion (1-2 level)

-To compare age and comorbidity, cost of surgery, rates of revision surgery, major medical complications, wound complications, mortality, and 30-day readmission rates.


RESULTS
Age: received spacers > decompression or fusion
Comorbidity: received spacers > decompression or fusion
Complications (major medical): spacer alone < decompression or fusion surgery
Hospital payments: fusion procedures > spacer surgery > decompression alone
-These associations persisted in multivariate models adjusting for patient age, sex, comorbidity score, and previous hospitalization.


CONCLUSION

Interspinous distraction procedures fewer complications, higher rates of revision surgery to compared with decompression or fusion.