Utilization of Lumbar Spinal Fusion in New York State: Trends and Disparities.

STUDY DESIGN Retrospective review of an administrative database. OBJECTIVE To observe New York statewide trends in lumbar spine surgery and to compare utilization of fusion according to hospital size and patient population. SUMMARY OF BACKGROUND DATA Over the last 30 years, studies have indicated increasing rates of spinal fusion procedures performed each year in the United States. There is no study investigating potential variability in this trend according to hospital volume. METHODS New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,882 lumbar spine surgery patients. New York State hospitals were categorized as low-, medium-, or high-volume and descriptive statistics were used to determine trends in spinal fusion. RESULTS The number of fusions per year increased 55% from 2005 to 2014. The ratio of fusion to nonfusion surgery increased from 0.88 to 2.67 at high-volume, from 0.84 to 2.30 at medium- volume, and from 0.66 to 1.52 at low-volume hospitals. In 2014, 22% of spine surgery patients at low-volume hospitals were either African Americans or Hispanics compared with 12% and 14% at high- and medium-volume hospitals, respectively. At high-volume hospitals, 33% of patients were privately insured and 3% had Medicare compared with 30% and 6% at low-volume hospitals. CONCLUSION The annual number of lumbar spinal fusions continues to increase, especially at high- and medium-volume hospitals. The percentage of patients treated surgically for lumbar spinal stenosis that undergoes fusion ranges from 53.2 to 66.4% depending on hospital volume. Individual surgeon opinion, patient disease characteristics, and socioeconomic factors may affect surgical decision making. Caucasians and private insurance patients most often receive care at high-volume hospitals. Minorities and patients with Medicaid are over-represented at low-volume centers where fusions are less often performed. Accessibility to care at high-volume centers remains a major concern for these vulnerable populations. LEVEL OF EVIDENCE 3.