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Study identifies increased use and regional differences related to intraoperative neurophysiological monitoring

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SAN FRANCISCO — The use of intraoperative neurophysiological monitoring in spine surgery has increased in recent years with marked geographic variation in its use seen in the United States, according to a presenter, here.

“The trend of increased use of intraoperative neurophysiological monitoring in simple spine cases and the financial implications of this trend, we believe warrants further exploration and also justification,” Whitney Allison Sheen, MD, said at the American Association of Neurological Surgeons Annual Meeting.

Using the Nationwide Inpatient Sample, Sheen and colleagues identified 408,255 spine procedures performed in the United States from 2007 to 2011. Overall, 15% of the cases were nonelective spine surgery and 85% were elective surgeries. Intraoperative neurophysiological monitoring (IONM) was used in 28,925 cases. Mean hospital charges, patient independence at discharge and iatrogenic nerve injury were compared with and without the use of IONM.  

Sheen said the use of IONM has increased yearly, from 1% of all spine cases in 2007 to 13% of all spine cases in 2011. IONM use ranged from a regional low of 8% of spine cases in the Northeast region of the United States to 21% of spine cases in the Western region in 2011. Every region of the United States, with the exception of the Northeast region, showed increased use of IONM during the study period. The use of IONM in discectomy for disc replacement also increased from 2.9% in 2008 to 8.9% in 2011.

Iatrogenic nerve injury occurred in 27 patients, which did not significantly decrease in cases where IONM was used. The mean hospital costs with the use of IONM were higher for both for elective and nonelective spine surgeries. Additionally, patients were more frequently independent at discharge when IONM was not used in either elective or nonelective admissions. ─ by Kristine Houck, MA, ELS

Reference:

Sheen WA. Paper #712. Presented at: American Association of Neurological Surgeons Annual Meeting; April 5-9, 2014; San Francisco.

Disclosure: Sheen has no relevant financial disclosures.