Long-term health care utilisation and costs after spinal fusion in elderly patients
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ORIGINAL ARTICLE
Long-term health care utilisation and costs after spinal fusion in elderly patients Thomas Andersen • Cody Bu¨nger • Rikke Søgaard
Received: 30 January 2012 / Revised: 9 May 2012 / Accepted: 5 August 2012 / Published online: 21 August 2012 Ó Springer-Verlag 2012
Abstract Purpose Spinal fusion surgery rates in the elderly are increasing. Cost effectiveness analyses with relatively short-length follow-up have been performed. But the longterm effects in terms of health care use are largely unknown. The aim of the present study was to describe the long-term consequences of spinal fusion surgery in elderly patients on health care use and costs using a health care system perspective. Methods 194 patients undergoing spinal fusion between 2001 and 2005 (70 men, 124 women) with a mean age of 70 years (range 59–88) at surgery were included. Average length of follow-up was 6.2 years (range 0.3–9.0 years). Data on resource utilisation and costs were obtained from national registers providing complete coverage of all reimbursed contacts with primary- and secondary health care providers. Data were available from 3 years prior fusion surgery until the end of 2009. Results Use of hospital-based health care increased in the year prior to and the first year following surgery. Hereafter it normalised to the level of the background population and was mainly composed of diseases unrelated to the spine. In contrast, the use of primary health care appeared to increase immediately after surgery and continued to increase to a level that significantly exceeded that of the background population. It could be demonstrated that the T. Andersen (&) C. Bu¨nger Spine Section, Orthopaedic Research Laboratory, Building 1A Orthopaedic Department, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark e-mail: [email protected] R. Søgaard CAST, Institute of Public Health, University of Southern Denmark, Odense, Denmark
increase was mainly due to an increasing number of general practitioner consultations. Conclusion Spinal fusion surgery in older patients does not generate excess hospital-based health care use in the longer term as compared with the background population, but primary care use increases. Keywords Spinal stenosis Spinal fusion Elderly Costs Health care utilisation
Introduction The estimated percentage of people above 60 years in developed countries is expected to increase steadily towards 2050 [28]. Thus an increased number of people will experience age-associated diseases. Within the field of spine surgery one of the most common diagnoses in the elderly is spinal stenosis. Several treatment options exist and although the choice of procedure is still debatable [5], there is evidence for the effect of decompression of neural structures with or without concomitant fusion [1, 19, 29]. Studies have shown the improvement in general health to be comparable with other well-established orthopaedic procedures such as hip and knee replacements [23]. Recent studies have shown an increase in spinal surgery proc
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