OBJECTIVES: Spinal lumbar fusion has been associated with high revision rates. Our study evaluated the two-year healthcare utilization associated with lumbar fusion surgery using comprehensive, contemporary data.

METHODS: Patients with lumbar-only fusion surgery between October 2015 to December 2020 and ≥ two years continuous enrollment post-surgery in the Merative MarketScan Commercial Claims database covering >100 million lives were identified. Outcomes included two-year follow-up for: reoperations with diagnoses of spinal complications; any new spinal surgery; healthcare costs; and costs associated with pseudarthrosis and infection. Exploratory outcomes included discharge disposition and post-operative filled prescription use. Variables included patient demographics, index surgery approach, number of levels fused and instrumentation use. Descriptive analytics were conducted for all outcomes. Healthcare costs were adjusted to 2022 inflation and analyzed using generalized linear models.

RESULTS: 14,527 patients with average age 52, including 56% females, were included in the analysis. The majority were treated in the inpatient setting (88%, hospital outpatient: 7%, ambulatory surgical care: 5%). The average Elixhauser index patient comorbidity score was 1.8 (standard deviation (SD): 1.6) and ~ 30% patients had ≥ 3 comorbidities. Diabetes affected 17% cases. Degenerative disc disease and deformity were diagnosed in 88.3% and 16.6% cases, respectively. One-level fusion was performed in 67% cases. At 2-year follow-up, new lumbar operations were performed in 11% cases, of which 57% had a diagnosis of spinal fusion complication at the time of the new lumbar procedure. Pseudarthrosis and infection were reported in 6% and 4% of all cases, respectively. Healthcare costs associated with pseudarthrosis and infection, without reoperation costs, averaged $32,302 (95% confidence interval (CI): $20,773-$43,831) and $80,539 (95%CI: $61,270-$99,807), respectively. When reoperations were performed, costs increased by $73,603 (95%CI: $57,519-$89,688).

CONCLUSIONS: For > 10% of patients, lumbar spinal surgery is associated with additional lumbar surgical interventions and high overall healthcare costs. Reoperation costs exceeded $70K.