Portal de Periódicos da CAPES

97. Geospatial clustering of lumbar fusion in the United States reveals racial and socioeconomic disparities

2022; Elsevier BV; Volume: 22; Issue: 9 Linguagem: Inglês

10.1016/j.spinee.2022.06.115

1878-1632

Nicholas Peterman, Anant Naik, Bailey MacInnis, Eunhae Yeo, Rajiv Dharnipragada, David T. Krist, Hana Hallak, Paul M. Arnold,

Spine and Intervertebral Disc Pathology

BACKGROUND CONTEXT Lumbar spinal fusion has been a well tolerated standard of care for decades and while multitudes of studies have examined its outcomes, none have yet cataloged the national trends in lumbar fusions from a national geospatial analysis perspective. This study aims to catalog national trends in lumbar fusion access, demographic disparities and surgical technique using Medicare sources from 2015-2019. METHODS Several public access databases were combined including National Provider Identifier (NPI) records, Center for Medicare Services (CMS) Medicare demographics, CMS registered medical centers, CMS provider billing, and US Census socioeconomic databases. All records were year-matched for 2015-2019 and combined on a county level in Python. All billed CPT codes for lumbar spinal fusion (22630, 22558, 22533, 22633, 22800, 22802, 22804, 22808, 22810, and 22612) were tracked by NPI, specialty and county. Patient demographics for each county were estimated based on the recorded overall patient demographics of physicians who billed lumbar fusions during the time period. The percentage of each specialty performing the fusions were also calculated. Total numbers of hospital and ambulatory surgical center beds were recorded to represent the medical infrastructure of each county. After removing counties without lumbar fusions billing during the time period, 914 countries remained for analysis. The database was then exported to GeoDa, a geospatial analysis software, for network-based analysis. Moran's I statistic was used to identify statistically significant, p < 0.05, hotspots, coldspots and spatial outliers for total lumbar fusions per county. Statistically significant groupings were then exported back to Python where summary tables were created and an ANOVA was conducted across 85 total socioeconomic, health and demographic variables. RESULTS A total of 592,011 lumbar spinal fusions were captured in this analysis with an average of 3.72% growth rate in procedures per year. These operations were performed by 1,805 neurosurgeons, 1,963 orthopedic surgeons and other specialties in sparse amounts. Orthopedic surgeons performed 146% of procedures performed by neurosurgeons. The average county had 795.74 fusions with 82.04% posterior, 17.36% anterior and 0.61% lateral approach. Estimated patient demographics were 43.11% male, 93.22% white and 19.02% on a Medicaid supplement. Thirty-one geospatial hotspots were located in coastal Florida, Southern California, Colorado and Washington with an average of 2749.13 fusions per county over the 5-year period. One hundred forty-six coldspot counties were located in Northern California, Greater Appalachia and southern Illinois with an average of 189.08 fusions per county. Compared to coldspots, hotspots were significantly (p <0.05) less likely to have patients on Medicaid supplements (12.78% to 22.14%), more likely to have greater medical infrastructure (6165.77 to 1060.75 beds per county), more likely to have male patients (45.33% to 42.95%), more likely to be in a metropolitan area (100% to 66%), less likely to be in poverty (12.64% to 14.83%), and with more median income ($61,114.77 to $52,862.23). CONCLUSIONS Our analysis captures a majority of all lumbar fusions in the United States. A vast majority of patients receiving lumbar fusions are on Medicare. Significant geospatial trends in surgical technique, access to care, and patient demographics are important to explore to understand the evolving community-level disparities in lumbar fusion. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Lumbar spinal fusion has been a well tolerated standard of care for decades and while multitudes of studies have examined its outcomes, none have yet cataloged the national trends in lumbar fusions from a national geospatial analysis perspective. This study aims to catalog national trends in lumbar fusion access, demographic disparities and surgical technique using Medicare sources from 2015-2019. Several public access databases were combined including National Provider Identifier (NPI) records, Center for Medicare Services (CMS) Medicare demographics, CMS registered medical centers, CMS provider billing, and US Census socioeconomic databases. All records were year-matched for 2015-2019 and combined on a county level in Python. All billed CPT codes for lumbar spinal fusion (22630, 22558, 22533, 22633, 22800, 22802, 22804, 22808, 22810, and 22612) were tracked by NPI, specialty and county. Patient demographics for each county were estimated based on the recorded overall patient demographics of physicians who billed lumbar fusions during the time period. The percentage of each specialty performing the fusions were also calculated. Total numbers of hospital and ambulatory surgical center beds were recorded to represent the medical infrastructure of each county. After removing counties without lumbar fusions billing during the time period, 914 countries remained for analysis. The database was then exported to GeoDa, a geospatial analysis software, for network-based analysis. Moran's I statistic was used to identify statistically significant, p < 0.05, hotspots, coldspots and spatial outliers for total lumbar fusions per county. Statistically significant groupings were then exported back to Python where summary tables were created and an ANOVA was conducted across 85 total socioeconomic, health and demographic variables. A total of 592,011 lumbar spinal fusions were captured in this analysis with an average of 3.72% growth rate in procedures per year. These operations were performed by 1,805 neurosurgeons, 1,963 orthopedic surgeons and other specialties in sparse amounts. Orthopedic surgeons performed 146% of procedures performed by neurosurgeons. The average county had 795.74 fusions with 82.04% posterior, 17.36% anterior and 0.61% lateral approach. Estimated patient demographics were 43.11% male, 93.22% white and 19.02% on a Medicaid supplement. Thirty-one geospatial hotspots were located in coastal Florida, Southern California, Colorado and Washington with an average of 2749.13 fusions per county over the 5-year period. One hundred forty-six coldspot counties were located in Northern California, Greater Appalachia and southern Illinois with an average of 189.08 fusions per county. Compared to coldspots, hotspots were significantly (p <0.05) less likely to have patients on Medicaid supplements (12.78% to 22.14%), more likely to have greater medical infrastructure (6165.77 to 1060.75 beds per county), more likely to have male patients (45.33% to 42.95%), more likely to be in a metropolitan area (100% to 66%), less likely to be in poverty (12.64% to 14.83%), and with more median income ($61,114.77 to $52,862.23). Our analysis captures a majority of all lumbar fusions in the United States. A vast majority of patients receiving lumbar fusions are on Medicare. Significant geospatial trends in surgical technique, access to care, and patient demographics are important to explore to understand the evolving community-level disparities in lumbar fusion.