Surgical treatment of spinal stenosis associated with lower 2-year mortality, costs
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Compared with nonsurgical treatment, surgical treatment of Medicare patients with single-level lumbar stenosis was associated with lower mortality rates and costs at 2 years, according to published results.
Raymond W. Hwang, MD, MEng, MBA, and colleagues used data from the Medicare National Database Fee for Service Files to retrospectively review outcomes in 145,347 patients who presented with lumbar stenosis with or without spondylolisthesis from 2011 to 2017. Among the 61,534 patients who presented with stenosis alone, 63.1% received single-level surgical treatment, while 47.7% of the 83,813 patients who presented with stenosis and spondylolisthesis received single-level surgical treatment. Surgeries included fusion, laminectomy or both fusion and laminectomy, according to the study. Outcome measures included 2-year mortality rates, 2-year total Medicare payments and spine-related health care utilization.
Overall, Hwang and colleagues found surgical treatment was associated with a 28% lower 2-year mortality rate compared with patients who received nonsurgical treatment. Researchers noted patients with stenosis alone who underwent laminectomy and patients with both stenosis and spondylolisthesis who underwent laminectomy with or without fusion had lower total Medicare payments compared with the nonsurgical cohort. They also noted utilization rates of pain medication, MRI and physical therapy were higher in nonsurgically treated patients.
“It is important to emphasize that, although we demonstrated significant associations between certain surgical treatments and outcomes, the causal inference that these treatments were responsible for the improved outcomes has not been proven,” the researchers wrote in the study. “Despite our careful risk-matching methodology, many unrecognized confounding factors may theoretically have biased the results,” they added.
“Nevertheless, considering the large sample size representing the entire Medicare population, we believe that our findings support the use of surgical intervention in well-selected patients,” they concluded.
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