Hospitals charged Medicare over $1.9 billion for more than 200,000 unnecessary back surgeries performed on older adults over a three-year period, according to a recent analysis by the Lown Institute. This staggering figure translates to one unnecessary surgery every eight minutes, highlighting a troubling trend in healthcare spending and patient safety.
The report focused primarily on two types of procedures: spinal fusions and vertebroplasties, the latter involving the injection of medical-grade cement into fractured spinal bones to alleviate pain. The prevalence of these surgeries has raised concerns due to their associated risks, which include serious complications such as infections, blood clots, and strokes. These complications can occur in up to 18% of patients undergoing such procedures.
Dr. Vikas Saini, president of the Lown Institute, emphasized the ethical imperative to reduce unnecessary invasive surgeries. He stated, “Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative.”
Rising Criticism of Back Surgery Practices
The increasing popularity of back surgeries has resulted in significant financial implications without a corresponding improvement in health outcomes. Numerous studies have shown that these surgeries can lead to heightened healthcare costs while failing to enhance patient recovery. In some cases, patients even experience increased pain following surgery, a condition known as “failed back surgery syndrome.”
From 2020 to 2023, the Lown Institute’s analysis of Medicare claims data revealed that over 17,000 patients faced unnecessary complications from spinal fusions, out of 99,000 total procedures. In light of these findings, Medicare has initiated efforts to impose stricter oversight on back surgeries, identifying them as a critical area for potential cost reduction.
As part of this initiative, vertebroplasties are included in the Centers for Medicare & Medicaid Services (CMS) pilot program for prior authorization, set to launch next year. This program aims to curb unnecessary expenditures within Medicare.
Geographical Disparities in Surgical Practices
The Lown Institute classified unnecessary spinal fusions as those performed on patients with low back pain but without significant underlying conditions, such as herniated discs or trauma. Similarly, unnecessary vertebroplasties were identified in patients with spinal fractures linked to osteoporosis, excluding fractures resulting from other conditions like bone cancer.
The overuse rate for spinal fusions averaged 13% across U.S. hospitals, while vertebroplasties had a 10% overuse rate, according to Lown’s data. Notably, states like Texas and Florida exhibited some of the highest rates of both types of unnecessary surgeries.
Among hospitals with significant overuse, one in three spinal fusions performed at certain facilities was deemed unnecessary. Prominent hospitals, including AdventHealth Orlando and Brigham and Women’s Hospital, were highlighted for having high rates of unnecessary procedures. Other institutions, such as Mount Nittany Medical Center in Pennsylvania and Concord Hospital in New Hampshire, also reported alarming overuse rates for spinal fusions.
For vertebroplasties, facilities like Kettering Health Miamisburg in Ohio, Shannon Medical Center in Texas, and Saint Elizabeth Florence Hospital in Kentucky were noted for excessive rates of these procedures.
As the healthcare system grapples with the implications of such findings, the focus remains on ensuring that patient safety and fiscal responsibility drive surgical decisions. The data from the Lown Institute serves as a critical reminder of the need for informed and judicious healthcare practices.
