Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Healthcare utilization”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 667 records · Page 37Linked to original sources
PubMed2002

Are high-volume surgeons and hospitals the most important predictors of in-hospital outcome for colon cancer resection?

BACKGROUND: Although recent studies have reported that high-volume surgeons and hospitals have better outcomes for colon cancer resections, it remains unclear whether there are other factors that are more important than volume. This study aims to evaluate the importance of the volume variables relative to other factors in an attempt to target specific areas for improving outcomes. METHODS: Using nationwide data from the Healthcare Cost and Utilization Program, full-model logistic regression was performed on all patients undergoing colon cancer resection. In hospital mortality was regressed against more than 30 different independent variables, including demographic factors (eg, age, gender, race, ethnicity, and socioeconomic status), burden of morbid and comorbid disease (prevalence and severity), and provider variables (eg, hospital size, location, teaching status, hospital and surgeon volume). A separate baseline probability analysis was then performed to compare the relative importance for all predictor variables. RESULTS: The sample size for this analysis was 22,408; 622 in-hospital deaths occurred (2.8%). Average age was 70 years old, 51% of particIpants were male, and 60% had at least 1 comorbid disease. An operation was elective (64%), urgent (19%), or emergency (15%). The significant predictors for mortality (at P <.05) included age, gender, comorbid disease (ie, cardiovascular, pulmonary, liver), operation severity (ie, emergency, urgent), and volume (both hospital and surgeon). The baseline probability analysis shows that the mortality for a baseline case is 12/1000. If this baseline case goes to a high-volume hospital or surgeon, the mortality will decrease to 11/1000 and 10/1000, respectively. If a patient with a baseline case of colon cancer also has coexistent liver disease or requires an emergency operation, mortality increases to 44/1000 and 45/1000, respectively. Overall, the volume variables, although statistically significant, have a relatively smaller effect on outcome compared with other factors. CONCLUSIONS: Whereas other factors have a stronger association with outcome than volume, volume is the only acutely mutable variable. Although the regionalization controversy (ie, using only high-volume surgeons or hospitals) is not solved with our findings, this study elucidates and compares the relative importance of several different factors on outcome, which is essential when considering the conclusions and implications of this type of policy-relevant outcomes research.

Aged↗
PubMed2005

Mental illness and principal physical diagnoses among Asian American and Pacific Islander users of emergency services.

The stigma of mental illness is one of the factors that prevents Asian Americans/Pacific Islanders (APIs) from seeking formal mental health services. A somatic complaint is more acceptable in expressing psychiatric/emotional distress. Admission diagnoses in API emergency service users with secondary psychiatric diagnoses were identified from the 2001 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). The sample consisted of 10,623 adult APIs. The study examined the differences in the six leading principal physical admission diagnoses between API emergency service users with psychiatric diagnoses and those without psychiatric diagnoses. Several of the study findings create concern (e.g., the higher percentage of APIs with psychiatric diagnosis who were discharged against medical advice, the high percentage admitted with medication intoxication). Further study is needed to provide guidance for clinical practice.

Adult↗
PubMed2005

Access to vision care in an urban low-income multiethnic population.

OBJECTIVE: This study applied a well-known, recently revised theoretical model of healthcare access and utilization, the Behavioral Model for Vulnerable Populations, to examine the relationship between access to care and utilization of eye care services among a multiethnic, predominately minority sample of residents from low-income public housing. DESIGN: Population-based, cross-sectional survey of community sample. SETTING: Urban Public Housing Communities in Los Angeles County, California. PARTICIPANTS: A geographically defined stratified random sample of 152 residents (86% Latino or African American) 40 years of age and older from three urban public housing communities. RESULTS: Only 62% of our sample of persons 40 years and older had received an eye examination within the past 2 years. Sixty-one percent of participants reported having vision care coverage. Yet, one out of four respondents claimed that no health care provider had ever told them that they needed an eye-examination. Applying multiple logistic regression and controlling for a number of predisposing, enabling, and need-for-care characteristics, the variables 1) receiving advice from health care providers for eye examination (OR = 3.9, p < 0.01), 2) possessing coverage for eye-care (OR = 3.2, p < 0.01), and 3) having regular and continuity of medical care (OR = 2.4, p < 0.01) remained significant predictors of eye-examination within the past 2 years. CONCLUSION: This study documents significantly diminished utilization of eye care services relative to recommended guidelines for a low-income, predominately minority sample of residents from public housing communities. We documented no association between presence of diabetes or hypertension and recency of eye examination. Affordability, continuity, and regular sources of care, as well as receiving physician advice, remain the core factors significantly associated with receiving vision care. These results underscore the need for continued efforts to ensure that the medically underserved minority have access to vision care services. These findings also point toward the urgent need for educational and motivational interventions that encourage health care providers serving underserved communities to promote eye examination, particularly among diabetic patients, hypertensive patients, and other individuals at risk for eye-related disease and complications.

Adult↗
PubMedDate not supplied

A national perspective of surgery in children with cerebral palsy.

PURPOSE: Children with cerebral palsy (CP) often require surgery, but may be at higher risk for surgical complications and poorer outcomes than children without CP. This study provides a national perspective of the children, hospitals and hospital course associated with the five most commonly performed surgeries in children with CP and compares this perspective to that of children without CP undergoing the same procedures. METHODS: Analysis of the 1997 Healthcare Cost and Utilization Project Kids' Inpatient Database. RESULTS: The most common surgeries performed in children with CP (n = 37 000) were gastrostomy tube placements (n = 1743), soft tissue musculoskeletal procedures (n = 1393), fundoplications (n = 1062), spinal fusions with instrumentation (n = 765) and bony hip surgeries (n = 651). Together, the five procedures accounted for nearly 50 000 hospital days and over 150 million dollars in hospital charges in 1997. The largest difference in outcomes between children with and without CP was seen in those undergoing surgery for scoliosis. CONCLUSIONS: Surgical procedures are frequent in children with CP. Their costs and impact on the US health care system are substantial. The findings provide a strong incentive to carefully study the benefits of the procedures and to develop interventions to improve outcomes, particularly in the case of scoliosis surgery.

Cerebral Palsy↗
PubMed2002

Burden of encephalitis-associated hospitalizations in the United States, 1988-1997.

Analysis of the National Hospital Discharge Survey data for 1988-1997 revealed a substantial disease burden associated with encephalitis in the United States: on average, there were nearly 19,000 hospitalizations (7.3 hospitalizations per 100,000 population), 230,000 hospital days, and 1400 deaths annually. For most encephalitis-associated hospitalizations (59.5%), the etiologic agent was unknown or not recorded; the most common etiologic categories among known causes were "viral" (38.2%) and "other infectious" (34.1%). The most common individual diagnoses with known agents were herpetic and toxoplasmic encephalitides (each associated with an annual average of 2100 hospitalizations). Human immunodeficiency virus infection was listed among discharge diagnoses for 15.6% of hospitalizations. Rates of encephalitis-associated hospitalization were highest for children <1 year old and persons > or =65 years old. The etiology of encephalitis was unknown for persons > or =65 years old significantly more often than it was for younger persons. The average cost of an encephalitis-associated hospitalization, as determined by the Healthcare Cost and Utilization Project for 1997, was $28,151, for an annual national cost of hospitalization of $650 million.

Adolescent↗
PubMed2005

More on RotaShield and intussusception: the role of age at the time of vaccination.

BACKGROUND: RotaShield, a vaccine intended to prevent severe rotavirus diarrhea, was withdrawn in July 1999, 9 months after it became available in the United States, because of a temporal association with intussusception events that occurred in vaccinated infants. We explore here the effect of age on the risk of intussusception. METHODS: We reanalyzed a case-control database of the Centers for Disease Control and Prevention by use of a 21-day window, to define vaccine-associated events. We obtained data on vaccine use from the National Immunization Survey and estimated the age-stratified background incidence of intussusception by use of Healthcare Cost and Utilization Project data. We combined these data to estimate how absolute risk varies with age and to model the projected population-attributable risk associated with 3 different vaccination schedules. RESULTS: We found that the incidence of intussusception associated with the first dose of vaccine increased with age. Infants > or = 90 days old accounted for 80% of cases of intussusception associated with a first dose but had received only 38% of first doses. Modeling of the recommended schedule of vaccination at ages 2, 4, and 6 months projected 1 intussusception event/11,000-16,000 vaccine recipients; modeling of a 2-dose schedule beginning in the neonatal period projected 1 intussusception event/38,000-59,000 vaccine recipients. CONCLUSIONS: The practice of initiating immunization after age 90 days, which we call "catch-up" vaccination, contributed disproportionately to the occurrence of intussusception associated with the use of RotaShield. A fully implemented 2-dose vaccination schedule begun during the neonatal period would lead to, at most, a 7% increase in the incidence of intussusception above the annual background incidence.

Age Factors↗
PubMed1998

The impact of candidemia on length of hospital stay, outcome, and overall cost of illness.

Although numerous studies have examined trends in nosocomial fungal infections, few have specifically addressed the cost of care associated with candidemia. This study analyzes the direct medical costs associated with treating candidemia in the United States. The study design was a cost-of-illness analysis estimating the average cost of candidemia for a single episode of care. Data were obtained from three sources: the 1993 Healthcare Cost and Utilization Project of the Agency for Health Care Policy and Research, the relevant literature, and a clinical expert in systemic fungal infections. The estimated cost (1997 U.S.$) of an episode of care for candidemia is $34,123 per Medicare patient and $44,536 per private insurance patient. The major cost associated with candidemia is that of an increased hospital stay. The estimated cost of care for candidemia may change in the future because of the use of more expensive antifungal treatments with improved safety and efficacy profiles.

Adolescent↗
PubMed2004

Economic burden of dehydration among hospitalized elderly patients.

PURPOSE: The cost of unnecessary hospitalizations associated with dehydration in elderly patients was studied. METHODS: The study involved a retrospective examination of 1999 data on hospital discharges from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. The procedure code for volume depletion was used to extract hospitalization episodes for patients > or = 65 years of age who had a principal diagnosis of dehydration and were discharged alive. Hospitalizations with procedure codes unrelated to dehydration were omitted. RESULTS: The descriptive findings indicated that hospitalized older patients with a principal diagnosis of dehydration averaged 80.4 years of age, were primarily white (82.5%), and were more likely to live in the community than in a nursing home. Hospitalizations for dehydration were more common in the South and less common in the West. The average length of stay (LOS) was 4.6 days. The average total hospital charge was dollars 7,442, and the average per diem charge was dollars 1,628. Regression analysis explained nearly half of the variation in charges for dehydration (R2 = 0.457). Average LOS and number of diagnoses were directly related to hospital charges, and age was inversely related. Higher charges were associated with being nonwhite, entering the hospital via the emergency room, having private insurance, having no insurance, having comorbidities, and being hospitalized in the West or in teaching or urban hospitals. In 1999, the potential national saving from avoidable hospitalizations in these patients could have been as much as dollars 1.14 billion. CONCLUSION: The economic burden associated with avoidable hospitalizations due to dehydration in elderly patients was substantial.

Aged↗
PubMedDate not supplied

Rural African American women's descriptions of mammogram quality.

The voices of rural women are frequently absent in discussions of quality healthcare. This study utilized a phenomenological research design to examine rural African American women's descriptions of mammogram quality. Twenty-three women in rural Georgia communities were interviewed. Participants desired quality mammogram experiences in which they were treated with kindness and respect, were given explanations of the mammogram procedure and outcome, and were cared for by health professionals who were competent in their roles.

Adult↗
PubMed1995

Long-term survival after intensive care unit admission with sepsis.

OBJECTIVE: To evaluate the long-term survival of critically ill patients with sepsis and to assess the factors predictive of long-term survival (> 1 month after admission date). DESIGN: Prospective, cohort study. SETTING: Medical/surgical intensive care unit (ICU) in a multidisciplinary community hospital. PATIENTS: All patients admitted to the ICU from January 1, 1987 to March 31, 1991 who both demonstrated clinical evidence of the systemic inflammatory response syndrome and yielded blood cultures positive for a bacterium or fungus (n = 153). INTERVENTIONS: Random set of procedures normally performed in an ICU setting. MEASUREMENTS AND MAIN RESULTS: Patient characteristics, including age, blood culture results, comorbid conditions, and severity of illness as estimated by the Acute Physiology Score of the Acute Physiology and Chronic Health Evaluation II prognostic system were recorded. Follow-up evaluation utilizing the National Death Index provided survival outcome for all patients 1 yr after hospital discharge. The mortality rate at hospital discharge was 51.0%, and mortality rates at 1 month, 6 months, and 1 yr after admission date were 40.5%, 64.7%, and 71.9%, respectively. A total of 33 patients survived beyond the period of observation. The analyses demonstrated the following findings: a) the survival rate was negatively correlated with the Acute Physiology Score up to 1 month after hospital admission date, but uncorrelated thereafter; b) fungal infections, such as Candida, had the shortest survival prospects of any blood-borne infection; and c) both malignancy and human immunodeficiency virus infection contributed to poorer outcomes, but differed in their patterns of long-term survival. CONCLUSIONS: The most critical period for surveillance of bacteremic patients was in months 2 through 6 after discharge, during which time, the percentage of patients surviving decreased dramatically. The degree of physiologic derangement, as measured by the Acute Physiology Score, was a useful measure of prognosis within the first month after the score was assessed at ICU admission. However, beyond this period, prognostic utility decreased significantly. Healthcare providers should use caution concerning the expected survival of hospitalized patients with human immunodeficiency virus, based on experience with distinct conditions, such as malignancies.

APACHE↗
PubMed2002

Limb amputation and limb deficiency: epidemiology and recent trends in the United States.

BACKGROUND: The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States. METHODS: Data from the Healthcare Cost and Utilization Project from 1988 through 1996 were used to calculate rates of congenital deficiency, trauma-related, cancer-related, and dysvascular amputations in the United States. Trends over time in adjusted rates were then examined using linear regression techniques. RESULTS: Dysvascular amputations accounted for 82% of limb loss discharges and increased over the period studied. Over all years, the estimated increase in the rate of dysvascular amputations was 27%. Rates of trauma-related and cancer-related amputations both declined by approximately half. The incidence of congenital deficiencies remained stable. CONCLUSIONS: The risk of amputations increased with age for all causes and was highest among blacks having dysvascular amputations. Increasing risk of dysvascular amputations, particularly among elderly and minority populations, is of concern and warrants further investigation.

Adolescent↗
PubMed2005

Racial differences in cesareans: an analysis of U.S. 2001 National Inpatient Sample Data.

OBJECTIVE: To evaluate racial differences in potentially unnecessary cesareans in the United States. METHODS: The 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze various maternal demographic and clinical parameters among women having cesarean deliveries. For the purpose of our study, if there were no diagnoses related to cesarean delivery on the discharge certificate, the cesarean was classified as potentially unnecessary RESULTS: Using our methodology, 11% of 540,174 primary and 65% of 371,863 repeat cesareans for the year 2001 in the United States were classified as potentially unnecessary. After controlling for age, payment source, ZIP income, admission day, region of the country, and hospital size, location, and teaching status, black women had a higher likelihood of having potentially unnecessary primary cesareans when compared with white (P < .001) or Hispanic women (P < .001). White women had a higher likelihood of having potentially unnecessary repeat cesareans than black women (P < .001), although the magnitude of the odds ratio for race was not as striking as in primary cesarean. Potentially unnecessary primary cesareans were also more likely to occur in women aged 35 years or older, Medicare patients, weekend admissions, or those residing in the South or Northeast. Potentially unnecessary repeat cesareans were more likely to occur in women younger than 35 years, in rural hospitals, and in weekday admissions. CONCLUSION: In the United States, racial differences exist in the proportion of cesarean deliveries that are potentially unnecessary. Further exploration of these differences is warranted. LEVEL OF EVIDENCE: III.

Adult↗
PubMed2005

A national estimate of the elective primary cesarean delivery rate.

OBJECTIVE: We describe national trends for elective primary cesarean delivery from 1994 to 2001, with attention to changes in indications. METHODS: We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Cesarean deliveries were identified by International Classification of Diseases, 9th Revision, Clinical Modification procedure and diagnostic codes; V codes identified all types of deliveries for denominators. Twelve indications for elective primary cesarean delivery were targeted. International Classification of Diseases, 9th Revision, Clinical Modification coding changes were also evaluated. RESULTS: After excluding women who had labored and previous cesarean deliveries, elective primary cesarean deliveries rose from 19.7% of all cesarean deliveries in 1994 to 28.3% in 2001, an increase of approximately 43.6%. The use of the identified indications for elective primary cesarean delivery increased for codes representing malpresentation, antepartum bleeding, hypertension and severe hypertension, macrosomia, unengaged head, preterm gestation, and maternal soft tissue disorders. Coding for herpes, multiple gestation, other uterine scar, and congenital central nervous system remained the same. Additionally, a new 1998 code for fetal heart rate abnormalities was rapidly adopted during the study period. CONCLUSION: A national estimate of the elective primary cesarean delivery rate shows a rising trend. Additionally, coded indications for these procedures are shifting. Further examination into the use and clinical implications of indications through national surveillance for elective primary cesarean delivery is important for future obstetric practice. A revision of the terminology classification used to identify indications for cesarean delivery procedures would aid in this effort. LEVEL OF EVIDENCE: III.

Adult↗
PubMed2006

Hospitalizations with respiratory illness among pregnant women during influenza season.

OBJECTIVE: To examine hospitalizations with respiratory illness among pregnant women in the United States during periods of influenza activity. METHODS: Data were obtained from the Healthcare Cost and Utilization Project National Inpatient Sample (NIS), the largest publicly available all-payer hospital discharge database. Hospitalizations for respiratory illness and pregnancy were classified with International Classification of Diseases, 9th Revision, Clinical Modification codes. Analyses were stratified by delivery status. Discharge characteristics, length of stay, and complications of delivery among hospitalized pregnant women with and those without respiratory illness were compared. RESULTS: During the 1998-2002 influenza seasons, 3.4 per 1,000 hospitalizations of pregnant women included diagnoses of respiratory illness. Characteristics of pregnancy hospitalizations associated with higher odds of respiratory illness were presence of a high-risk condition for which influenza vaccination is recommended (adjusted odds ratio [OR] 3.2, 95% confidence interval [CI] 3.0-3.5 and OR 6.0, 95% CI 5.2-6.9 for nondelivery and delivery, respectively), Medicaid/Medicare as primary expected payer of care (OR 1.2, 95% CI 1.1-1.3 and OR 1.9, 95% CI 1.7-2.2 for nondelivery and delivery, respectively), and hospitalization in a rural area (OR 1.2, 95% CI 1.1-1.4 for nondelivery). During influenza season, hospitalized pregnant women with respiratory illness had significantly longer lengths of stay and higher odds of delivery complications than hospitalized pregnant women without respiratory illness. CONCLUSION: Hospitalizations with respiratory illness among pregnant women during influenza season are associated with increased burden for patients and the health care system. Intervention efforts to decrease influenza-related respiratory morbidity among pregnant women should be encouraged. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMed2006

Incidence and determinants of peripartum hysterectomy.

OBJECTIVE: Most studies of peripartum hysterectomy are conducted in single institutions, limiting the ability to provide national incidence estimates and examine risk factors. The objective of this study was to provide a national estimate of the incidence of peripartum hysterectomy and to examine factors associated with the procedure. METHODS: We used data for 1998-2003 from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, an annual nationally representative survey of inpatient hospitalizations. Peripartum hysterectomy was defined as a hysterectomy and delivery occurring during the same hospitalization. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for maternal and hospital characteristics using logistic regression. RESULTS: During 1998-2003, an estimated 18,339 peripartum hysterectomies occurred in the United States (0.77 per 1,000 deliveries). Compared with vaginal delivery without a previous cesarean delivery, the ORs of peripartum hysterectomy for other delivery types were as follows: repeat cesarean, 8.90 (95% CI 8.09-9.79); primary cesarean, 6.54 (95% CI 5.95-7.18); and vaginal birth after cesarean, 2.70 (95% CI 2.23-3.26). Multiple births were associated with an increased risk compared with singleton births (OR 1.41, 95% CI 1.16-1.71). CONCLUSION: Our results suggest that vaginal birth after cesarean, primary and repeat cesarean deliveries, and multiple births are independently associated with an increased risk for peripartum hysterectomy. These findings may be of concern, given the increasing rate of both cesarean deliveries and multiple births in the United States. LEVEL OF EVIDENCE: III.

Adolescent↗
PubMedDate not supplied

Racial and economic disparity and the treatment of pediatric fractures.

Disparity in the treatment of various medical conditions in patient groups with differing racial and economic backgrounds has increasingly been reported. This paper examines the relationship between baseline racial and economic factors and the treatment of pediatric long-bone fractures. The 2000 Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Database (KID) was used to retrospectively examine the incidence and treatment of pediatric fractures. Data were included for supracondylar humerus (n = 2,957), femoral shaft (n = 1,726) or radius and ulna forearm fracture (n = 828) as their primary diagnosis were studied. Hispanic (78%) and black (82%) patients were more likely to receive closed reduction with internal fixation (percutaneous pinning) of supracondylar humerus fractures than whites (73%, P = 0.02). Despite a fairly large sample size, differences in treatment of supracondylar humerus fractures across primary payer or income groups were not statistically significant. Patients with femur fractures and private insurance were more likely to be treated with an external fixation device (7.2%) than patients in the Medicaid (3.8%) or self-pay (4.5%) groups (P = 0.015). No statistically significant difference was found in the treatment of forearm fractures across racial, primary payer or income groups. Racial and economic disparity is an important issue in medicine today. This study did demonstrate statistically significant differences in the treatment of pediatric supracondylar humerus across racial groups, with Blacks and Hispanics being more likely to receive percutaneous pinning of these injuries than Whites. Private insurance patients were also more likely to have femoral shaft fractures treated with an external fixator device than patients with Medicaid or self-pay as their primary payer. However, the clinical significance of these differences is not clear. Further research is needed to gain a more complete understanding of disparities in medicine, and their etiologies, in order to work towards optimizing the quality of medical care for all patient groups.

Black People↗
PubMedDate not supplied

Spinal surgery in children with idiopathic and neuromuscular scoliosis. What's the difference?

We compared children who were hospitalized for the management of idiopathic scoliosis (IS) and neuromuscular scoliosis (NMS) via analysis of the 2000 Healthcare Cost and Utilization Project Kid Inpatient Database. Children with NMS had longer lengths of stay (9.2 vs. 6.1 days, P < 0.001), higher total charges (66,953 US dollars vs. 47,463 US dollars, P < 0.001), more diagnoses (6.3 vs. 2.5, P < 0.001), and more total procedures (4.2 vs. 3.0, P < 0.001) than did children with IS. Children with NMS more frequently developed pneumonia (3.5% vs. 0.7%, P < 0.001), respiratory failure (24.1% vs. 9.2%, P < 0.001), urinary tract infections (5.3% vs. 0.7%, P < 0.001), and surgical wound infections (1.3% vs. 0.3%, P < 0.001). Overall, 1570 children with NMS underwent spinal surgery, totaling to 105 US dollars million in hospital charges and 14,444 hospital days. We conclude that children with NMS experience significantly more complicated and costly hospitalizations than do children with IS. These results may add information on preoperative care, surgical decision-making, discussions of informed consent, and the provision of anticipatory guidance for children and their caregivers.

Adolescent↗
PubMed2005

United States trends in lumbar fusion surgery for degenerative conditions.

STUDY DESIGN: Retrospective cohort study using national sample administrative data. OBJECTIVES: To determine if lumbar fusion rates increased in the 1990s and to compare lumbar fusion rates with those of other major musculoskeletal procedures. SUMMARY OF BACKGROUND DATA: Previous studies found that lumbar fusion rates rose more rapidly during the 1980s than did other types of lumbar surgery. METHODS: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1988 through 2001 to examine trends. U.S. Census data were used for calculating age and sex-adjusted population-based rates. We excluded patients with vertebral fractures, cancer, or infection. RESULTS: In 2001, over 122,000 lumbar fusions were performed nationwide for degenerative conditions. This represented a 220% increase from 1990 in fusions per 100,000. The increase accelerated after 1996, when fusion cages were approved. From 1996 to 2001, the number of lumbar fusions increased 113%, compared with 13 to 15% for hip replacement and knee arthroplasty. Rates of lumbar fusion rose most rapidly among patients aged 60 and above. The proportion of lumbar operations involving a fusion increased for all diagnoses. CONCLUSIONS: Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications.

Cohort Studies↗