Risky, Costly Back Surgery Rose 15-Fold in 5 Years (Update1)

[FarCenter]

By David Olmos

April 6 (Bloomberg) -- Complex back surgeries in older adults surged 15-fold from 2002 to 2007, driving up medical costs and the risk that patients may develop life-threatening complications, a study found.

The operation, complex spinal fusion, accounted for 14.6 percent of all back surgeries for Medicare patients in 2007, up from less than 1 percent in 2002, researchers said today in the Journal of the American Medical Association. Patients who underwent the procedure showed a doubled rate of life- threatening complications, 5.6 percent, compared with a simpler back surgery called decompression.

The study is the first to look at the rate of spinal surgery and its complications and cost in a large group of Medicare patients, said the lead researcher, Richard Deyo. About 660,000 back surgeries, some of which use devices made by Medtronic Inc. and Zimmer Holdings Inc., were performed in the U.S. in 2009, according to Millenium Research Group, a medical market research company in Toronto.

“This is an example where lower-cost procedures are just as good and safer, as well as being less expensive,” Deyo, a researcher at Oregon Health & Science University in Portland, Oregon, said in a telephone interview.

The more complicated surgery generated average hospital charges of $80,888 compared with an average of $23,724 for the simpler operation, the research found.

<SNIP>http://www.bloomberg.com/apps/news?pid=20601124&sid=atshJuBcE.C8

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This is a procedure that should be evaluated for cost-effectiveness. Looks like it is just a new profit center for surgeons and hospitals.

[TreasonousBastard]

1. This was reported on NPR this morning with the sage observation...

that the profit from back surgery being so high just might be one reason why it is so prevalent.

My observation is that Medicare is approving these expensive operations, as it approves a lot of unnecessary stuff, and if an insurance company would pay only for the cheaper alternative treatments, even if they worked it would be crucified.

[FarCenter]

2. HCR sets up a “Patient-Centered Outcomes Research Institute" to evaluate treatments

Health care reform bill 101: Will it make health care more effective?

Buried within the massive new US health care reform law is a small provision that in years to come could have a major effect on the kinds of treatments that American patients receive.

The provision requires the federal government to set up something called a “Patient-Centered Outcomes Research Institute.” It sets aside $500 million in seed money for this new nonprofit organization, which is supposed to become a national guiding force for comparative effectiveness research.

What’s that? Simply put, comparative effectiveness research takes a particular health problem, then pits different ways of treating that problem against one another, in an attempt to find which, if any, is a more effective way to maintain or restore patient health.

<SNIP>http://www.csmonitor.com/USA/Politics/2010/0326/Health-care-reform-bill-101-Will-it-make-health-care-more-effective

[TreasonousBastard]

5. I heard about that. Last week my Congressman had a...

local HCR info session and my question was about skyrocketing medical costs. He mentioned this amongst a bunch of other potential solutions in the bill.

Everyone agrees the bill is not perfect, but there are these hidden treasures in there that are coming out if we don't all hyperventilate and toss it before it has a chance to work.

[elfin]

3. I could not walk, nerves were going in my legs, MRI, scans etc.

revealed a LONG list of conditions, all preceded by "severe" -- ex. severe scoliosis, severe stenosis etc.

Went for opinions to both neurosugeons and orthopedic spinal specialists. ALL but one said to operate with a 6 month complicated recovery. Supposedly the top docs -- the last one, head of spinal surgery at the hospital affiliated with a med school said he would not operate unless I was prepared to die or be completely paralyzed due to the riskiness of the procedure. He told me to "walk", even very short times with a walker and as soon as possible get to a therapy pool and walk in water.

It has taken many months, but now I am pain free and cane free. So yes, from my experience, the recommendations for complex surgery are much more frequent than the "try everything else first" approach.

Walking in warm water worked a miracle for me - hope no one here has such a condition that they are considering back surgery.

[Lydia Leftcoast]

4. My brother is a specialist in occupational medicine, so he sees a lot of back problems

He got kicked out of one group practice for not referring enough people for surgery.

His approach is to try low tech methods first. Sometimes the problem is not in the spine but in a muscle imbalance (muscles work in pairs, and sometimes one or the other becomes "too weak" for its partner) that can be corrected through massage therapy and exercises to strengthen the muscles that are functioning poorly or changes in work habits.

The same is true of any other chronic musculoskeletal pain. Try the low-tech methods before resorting to surgery.

He has also told me that many people without back pain appear to have abnormal spinal disks on X-rays or MRIs, so a spinal disorder may not be the cause of one's pain, even if the X-rays indicate it.

He's had patients who were still in pain after expensive surgery but recovered after a course of massage therapy.

[trayfoot]

6. I don't dispute this report...

and, I am not in the Medicare category, but if I had not had expensive back surgery in 1987 (at the age of 37), I would have been long dead! I had a problem called spondilolethisis (sp?) My lower back was broken. In '87, this was experimental surgery and only a couple doctors did it nation-wide. They fuse, decompress, put in plates and screws. It worked like a miracle for me! In 2005, I had to have it again to replace plates & screws, decompress again, clean out arthritis. What concerns me about these reports, they tend to stroke with a broad brush! There WILL be people who desperately need these kinds of surgeries to live or improve their quality of life. I'm all for the "less expensive" solution IF it is medically advisable. I would hate for people to not get these surgeries who are in as bad a shape as I was.

[cutlassmama]

7. Same here. I'd be graveyard dead because the pain was so bad that I would

not have wanted to live. I thank God every day that I had surgery.

[Taverner]

8. Because the economy is down, and people have some time on their hands

If they are employed, or otherwise have Health Insurnace, they scheduled them