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Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations – Lumbar Fusion

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The article is a retrospective study that analyzes Medicare data to identify trends in lumbar fusion incidence and techniques. The study uses geospatial analysis and census data to examine the variations in lumbar fusion procedures across different locations and specialties. The results show that there is significant variation in the utilization and technique choices for lumbar fusion, indicating a lack of consensus in its application. The study suggests that this variance in treatment may result in both over- and under-treatment across the nation

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSIONS: The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the non-standardization of lumbar fusion indication has led to both over- and under- treatment across the nation.

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Spine (Phila Pa 1976). 2023 Aug 23. doi: 10.1097/BRS.0000000000004807. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective study with epidemiologic analysis of public Medicare data.OBJECTIVE: This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations.SUMMARY OF BACKGROUND DATA: With an aging population and new technologies, lumbar fusion,

Spine (Phila Pa 1976). 2023 Aug 23. doi: 10.1097/BRS.0000000000004807. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective study with epidemiologic analysis of public Medicare data.

OBJECTIVE: This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations.

SUMMARY OF BACKGROUND DATA: With an aging population and new technologies, lumbar fusion is an increasingly common procedure. There is controversy, however, regarding which indications and techniques achieve optimal outcomes, leading to significant inter-surgeon variation and potential national disparities in care.

METHODS: Medicare billing datasets were supplemented with Census Bureau socioeconomic data for 2013 to 2020. These databases listed lumbar fusions billed to Medicare by location, specialty, and technique. Hotspots and coldspots of lumbar fusion incidence and technique choice were identified with county-level analysis and compared with Mann-Whitney U. A linear regression of fusion incidence and a logistic regression of lumbar fusion hotspots/coldspots were also calculated.

RESULTS: Between 2013 and 2020, 624,850 lumbar fusions were billed to Medicare. Lumbar fusion hotspots performed fusions at nearly five times the incidence of coldspots (101.6 to 21.1 fusions per 100,000 Medicare members) and were located in the Midwest, Colorado, and Virginia while coldspots were in California, Florida, Wisconsin, and the Northeast. Posterior and posterolateral fusion (PF/PLF) were the most favored techniques, with hotspots in the Northeast. Combined PF/PLF and posterior interbody fusion was the second most favored technique, predominantly in Illinois, Missouri, Arkansas, and Colorado.

CONCLUSIONS: The geographic distribution of lumbar fusions correlates with variations in residency training, fellowship, and specialty. The geospatial patterning in both utilization and technique reflects a lack of consensus in the application of lumbar fusion. The strong variance in utilization is a potentially worrying finding that could suggest that the non-standardization of lumbar fusion indication has led to both over- and under- treatment across the nation.

LEVEL OF EVIDENCE: Level III (Retrospective).

PMID:37612890 | DOI:10.1097/BRS.0000000000004807

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Understanding Geospatial Trends in Lumbar Fusion Incidence and Technique in Medicare Populations

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Spine (Phila Pa 1976). 2023 Aug 23. doi: 10.1097/BRS.0000000000004807. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective study with epidemiologic analysis of public Medicare data.OBJECTIVE: This study seeks to utilize geospatial analysis to identify distinct trends in lumbar fusion incidence and techniques in Medicare populations.SUMMARY OF BACKGROUND DATA: With an aging population and new technologies, lumbar fusion

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