Cost and Complications of Single-Level Lumbar Decompression in Those Over and Under 75

A Matched Comparison

Samuel Rosas, MD, MBA; Ziyad O. Knio, MD; Anirudh K. Gowd, MD; T. David Luo, MD; Cynthia L. Emory, MD, MBA; Tadhg J. O'Gara, MD

Disclosures

Spine. 2021;46(1):29-34. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective database analysis.

Objective: This study aimed to compare costs and complication rates following single-level lumbar decompression in patients under age 75 versus patients aged 75 and older.

Summary of Background Data: Lumbar decompression is a common surgical treatment for lumbar pathology; however, its effectiveness can be debated in elderly patients because complication rates and costs by age group are not well-defined.

Methods: The Medicare database was queried through the PearlDiver server for patients who underwent single-level lumbar decompression without fusion as an index procedure. The 90-day complication and reoperation rates were compared between age groups after matching for sex and comorbidity burden. Same day and 90-day costs are compared.

Results: The matched cohort included 89,388 total patients (n = 44,694 for each study arm). Compared to the under 75 age group, the 75 and older age group had greater rates of deep venous thrombosis (odds ratio [OR] 1.443, P = 0.042) and dural tear (OR 1.560, P = 0.043), and a lower rate of seroma complicating the procedure (OR 0.419, P = 0.009). There was no difference in overall 90-day reoperation rate in patients under age 75 versus patients aged 75 and older (9.66% vs. 9.28%, P = 0.051), although the 75 and older age group had a greater rate of laminectomy without discectomy (CPT-63047; OR 1.175, P < 0.001), while having a lower rate of laminotomy with discectomy (CPT-63042 and CPT-63030; OR 0.727 and 0.867, respectively, P = 0.013 and <0.001, respectively). The 75 and older age group had greater same day ($3329.24 vs. $3138.05, P < 0.001) and 90-day ($5014.82 vs. $4749.44, P < 0.001) mean reimbursement.

Conclusion: Elderly patients experience greater rates of select perioperative complications, with mildly increased costs. There is no significant difference in overall 90-day reoperation rates.

Level of Evidence: 3

Introduction

Lumbar spine surgery is becoming increasingly common in the United States across all age groups.[1] In cases of symptomatic lumbar spinal stenosis (LSS) refractory to nonoperative treatment, lumbar decompression is considered a cost-effective treatment with good outcomes and low complication rates.[2–5]

Increasing patient age is associated with poor outcomes following lumbar decompression.[6,7] Some have proposed that age is an independent predictor of outcome, whereas others attribute this relationship to the increasing number and/or burden of comorbidities that come with aging.[8] Interpretation of this relationship is further complicated by the variability in measured outcomes, that is, patient-reported outcomes, radiographic outcomes, adverse event rates, or some combination of tools.[9–12]

As the nation's cohort of patients who undergo decompression procedures increases both in size and in heterogeneity, it will be increasingly important to interpret specific complication rates by age group. Moreover, with the ever-changing trends in payment models and cost structures, there is a need to evaluate the economic effects of non-modifiable risk factors such as age. This interest in economic expenditure is also of interest secondary to the increasing trends of minimally invasive procedures, outpatient surgery, and bundle payment models.

Therefore, this study aimed to compare rates of complication and reoperation following single-level laminectomy in patients under age 75 versus patients aged 75 and older. This study also compares same-day and 90-day costs of these procedures by age.

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