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Complex Spinal Operations Soar Despite Drawbacks
Date:4/6/2010

ared to 2.3 percent of those undergoing the simpler surgery. The likelihood of a life-threatening complication was nearly three times higher for those having a complex fusion procedure.

Patients who had complex fusions also spent an average of two days more in the hospital and had average hospital costs of $80,888, compared to $23,724 for those having simpler operations. Chances of returning to the hospital within 30 days were nearly doubled -- 13 percent for those having a complex procedure, 7.8 percent for those having decompression.

The surgical literature does not appear to justify the extra cost and hazard of the complex procedures for most people, Deyo said. "Most of the evidence suggests that in terms of pain relief and functional recovery, there is not much advantage in terms of complex procedures," he said. "There is even a possibility that the net benefit of surgery is lessened because of this."

But many surgeons prefer to do complex procedures as a matter of pride, Deyo said. "They like to be seen as innovators."

Also, the payoff is bigger with complex fusions, he said. The reality is that financial incentives are aligned in such a way as to favor the more complex procedures, he added. Although "many surgeons genuinely believe that more complex procedures are more advantageous," Deyo said that view is "shaped heavily by manufacturers of surgical implants and devices."

"The incentives are such that if there is no difference in risk to patients and people are faced with alternatives that profit them a little or a lot, a certain number of people will choose a lot," said Dr. Eugene J. Carragee, professor of orthopedic surgery at Stanford University School of Medicine, who wrote an accompanying editorial. "It appears that the bigger operations are being done more than the pathology necessarily warrants."

The severity of spinal stenosis has not increased over the past few years, Carragee said. "Without much cha
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