Increasing demand for posterior spinal fusion procedures will strain healthcare systems, new study suggests

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The demand for posterior spinal fusion procedures is expected to increase by more than 80% by 2060. In addition, the demand will be even greater among older patients, who often need more costly care, and so placing an enormous strain on healthcare systems. These are the key projections to come from a study published in Clinical Orthopaedics and Related Research by Vincent Heck (University of Cologne, Cologne, Germany) et al.

The study looked at how the use of posterior spinal fusions in Germany is expected to change, if current trends continue, from 2019 through 2060, as well as how the use of posterior spinal fusions in Germany is expected to change depending on patients’ age and gender during this same time period.

Heck et al examined comprehensive nationwide data provided by the German Federal Statistical Office to quantify posterior spinal fusion rates as a function of calendar year, age, and gender. According to the researchers, because there is a lack of evidence regarding future trends in the use of posterior spinal fusions, an autoregressive integrated moving average model on historical procedure rates from 2005 to 2019 in relation to official population projections from 2020 to 2060 was chosen to forecast future absolute numbers and incidence rates of this procedure in Germany.

Heck and colleagues predict that the use of posterior spinal fusion will increase to 102 procedures per 100,000 residents by 2060, an increase of about 83% compared with the years 2005 to 2019. In addition, the number of women undergoing the surgery will be 1.3-fold higher by 2060.

The research also found that the highest estimated increase will be among patients 75 years and older, with 38,974 posterior spinal fusions projected to be performed in 2060 compared with 14,657 in 2019. This trend will apply both to older women and men, with a 246% increase in the total number for women 75 years and older and a 296% increase for men 75 years and older. At the same time, the number of posterior spinal fusions in all age groups younger than 55 are projected to stay constant or even decline up to 2060.

As a result, the implications for healthcare systems include that a larger number of patients undergoing posterior spinal fusion surgery will have age-related comorbid conditions such as osteoporosis, cardiovascular disease, and age-related loss of muscle mass. Also, the population of patients having the surgery will be at increased risk of postoperative complications, longer hospital stays, and being discharged to skilled nursing facilities or other places besides their homes, ultimately resulting in higher healthcare costs.

Heck et al stated: “Our findings suggest that increasing use of posterior spinal fusion, particularly in patients 75 years and older, will challenge healthcare systems worldwide if current trends persist.

“Given the known risk factors associated with the surgical treatment of older patients, we think anticipatory human and financial resource planning, frailty as a focus of research, and the development of interinstitutional protocols that focus on effective perioperative medical care for these patients will be important elements of managing these trends in the future.”


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