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Hospitals performed more than 200,000 unnecessary back surgeries over a three-year period, according to an analysis by the Lown Institute, a health care watchdog group.
The useless treatments put patients at risk for complications and cost Medicare about $2 billion, the analysis found. Furthermore, there was a large variation in rates of overuse among individual hospitals, ranging from zero to more than half of procedures.
Journalists can use the analysis to call attention to hospitals with high rates of overuse and inform patients about the risks of unnecessary back surgery.
How the analysis was performed
Researchers used Medicare claims data to assess three interventions that are commonly performed in patients for whom there is little or no evidence of a clinical benefit:
- Spinal fusion — joining two or more vertebrae.
- Laminectomy — removing part of the lamina, a bony arch that protects the spinal cord and nerve roots.
- Vertebroplasty — injecting bone cement into a broken vertebra.
Most back pain is related to aging and has no specific cause. For such patients, clinical trials show that spinal fusion and laminectomy — which are often performed together — provide little or no benefit compared to conservative treatment such as exercise.
Sham-controlled trials have shown that vertebroplasty has little or no benefit for patients with spinal fractures caused by osteoporosis.
Procedures were not counted as overuse when the patient had a diagnosis for which surgery was indicated, such as scoliosis for spinal fusion and laminectomy, or bone cancer for vertebroplasty.
Findings
The Lown Institue analysis revealed a 14% average overuse rate for spinal fusion and laminectomy, with individual hospitals’ rates ranging from 1% to nearly 63%. The average overuse rate for vertebroplasty was 11%, with rates from 0% to 55.5%.
Researchers also examined the connection between unnecessary surgeries and industry funding. The 3,454 physicians who performed unnecessary procedures collectively received $64 million in compensation from device and drug companies, according to an analysis of Open Payments data conducted by Conflixis, an AI company that probes conflicts of interest in health care.
Note: The analysis used three years of the most recently available Medicare claims data, which was 2020-2022 for Medicare fee-for-service and 2019-2021 for Medicare Advantage. Only hospitals that performed 500 or more procedures were included. That amounted to 2,545 hospitals for spinal fusion and laminectomy and 2,417 for vertebroplasty.
Risks to patients
Fusion and laminectomy can cause complications such as infection, blood clots, heart and lung problems, paralysis, stroke and even death. Vertebrae fail to fuse between 10% and 40% of the time.
Vertebroplasty complications include bleeding, fever, infection and cement leakage. The latter can lead to blood clots in the brain or lung, heart damage, and death.
And unnecessary surgery can leave scar tissue and stiffness that triggers a cascade of further procedures, Sohail Mirza, M.D., an orthopedic surgeon and Dartmouth College professor who specializes in spine procedures, said during a Lown webinar.
“I think the literature is very clear that once you have any kind of back surgery, you’re on the path to have more and more back surgeries,” Mirza said.
Insurers pay anyway
Despite the risks and lack of benefits, Mirza said surgeries not supported by evidence “pass under the radar” as Medicare and private insurers continue to cover them.
Spine surgeries can generate significant revenue for hospitals, and physicians may urge patients to have surgery before trying noninvasive strategies, speakers noted during the webinar.
Getting a second opinion is one idea presented in a Lown article, Five ways to reduce back surgery overuse.
Claire Brockbank, director of policy and strategy for a health care fund for property service workers, said her organization minimizes out-of-pocket costs for physical therapy as part of a strategy to discourage expensive procedures that do more harm than good.
“In our eyes quality and cost go hand in hand, and people don’t always think that in healthcare,” Brockbank said.
Resources
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