Back surgeries: Low-value care swells Medicare spending

An unnecessary back surgery is performed on an older adult every eight minutes, putting thousands of patients at risk and increasing Medicare spending, according to new research from the Lown Institute.

Researchers analyzed hospital data for common back surgeries, including spinal fusion, laminectomy and vertebroplasty, which clinical trials have repeatedly shown lack of benefit for certain patients.

Patients with low-back pain caused by aging (excluding cases with neurologic symptoms, trauma or structural abnormalities) receive little to no benefit from spinal fusion or laminectomy. Additionally, patients with spinal fractures due to osteoporosis (excluding cases with bone cancer, myeloma or hemangioma) receive little to no benefit from vertebroplasty.

The Lown Institute found that over 200,000 procedures met criteria for overuse from 2019 to 2021, leading to an estimated $2 billion in Medicare spending.

"We trust that our doctors make decisions based on the best available evidence, but that's not always the case," Vikas Saini, M.D., president of the Lown Institute, said in a press release. "In spinal surgery, as with other fields of medicine, physicians routinely overlook evidence to make exceptions, sometimes at shockingly high rates. This type of waste in Medicare is costly, both in terms of spending, and in risk to patients."

In spinal surgery, as with other fields of medicine, physicians routinely overlook evidence to make exceptions, sometimes at shockingly high rates. This type of waste in Medicare is costly, both in terms of spending, and in risk to patients.

Among hospitals performing at least 500 total procedures, Mount Nittany Medical Center in Pennsylvania has the highest rate of unnecessary spinal fusion/laminectomy in the nation. The hospital performed 535 procedures and 336 of them met overuse criteria (62.8%). The researchers also found that a single physician is responsible for 92% (308) of those overuse procedures.

Significant variations in spinal fusion/laminectomy overuse rates exist even among the country's top hospitals, including those on the U.S. News & World Report Honor Roll for America's Best Hospitals.

For instance, UC San Diego Medical Center performed 783 procedures with only 15 meeting the criteria for overuse (1.2% overuse rate), while the Hospital of the University of Pennsylvania performed 641 procedures with 209 meeting overuse criteria (32.6% overuse rate).

Approximately 30 million people seek medical care for spine problems each year. While surgery can be an appropriate treatment for some, many procedures are performed with little to no evidence of benefit. Risks of these surgeries include infection, blood clots, stroke, heart and lung issues, paralysis and even death.

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.