Spinal surgery should be the last resort because of complications and cost

Aug 26 2011
When back pain occurs - whether from an athletic injury or degenerative disc disease - most orthopedic healthcare providers recommend trying conservative treatments before considering a surgery.

These treatments include limited bed rest, icing or hot compresses, anti-inflammatory medications, physical therapy or, in some cases, epidural injections. Often, these approaches produce satisfactory results in terms of pain reduction or elimination and restoration of mobility. Individuals who have benefited from conservative treatments can safely say that they probably avoided surgery complications that can sometimes cause greater pain and diminished quality of life than the back condition itself.

However, few patients realize that successful non-surgical interventions can also save them a lot of money. This is not only because surgeries tend to be expensive - especially if not covered or only partially covered by insurance - but also because the high risk of complications with these procedures causes a lot of intraoperative waste. For example, spinal implants are not always properly handled and inserted, and sometimes have to be removed and discarded. Needless to say, these products are expensive, and it is their cost that drives the expenses related to spinal surgeries and healthcare in general.

Intraoperative waste was the subject of a study that will be published in the September 1 issue of the journal Spine.

In it, the researchers found that that intraoperative waste occurred in more than 20 percent of procedures that they studied over a period of 25 months at one academic center in the U.S. Moreover, monthly costs stemming from surgical waste were found to be, on average, $17,680. In the context of the entire country, this may amount to as much as $127 million each month.

Fortunately, the team found that implementing awareness programs for orthopedic surgeons can significantly cut these costs, benefiting the providers, their patients and healthcare programs such as Medicare that are struggling under the weight of healthcare expenses.

In particular, the researchers found that after such programs were presented at this academic center, the incidence of waste dropped by nearly a half, to 10.3 percent. The monthly costs fell to $5,876, also a significant reduction.

Overall, the educational program caused this type of waste as a proportion of total operative spine budget to go down to 1.2 percent from 4.3 percent.

The importance of these findings stems from the fact that back operation is the most common type of surgery performed in the U.S., and the American Association of Neurological Surgeons estimates that some 4.6 million Americans will need it at some point in their lives. Moreover, the number of seniors is increasing, a trend that is expected to swell the ranks of orthopedic patients in the years to come. According to the Department of Health and Human Services Administration on Aging, the number of individuals older than 60 currently stands at nearly 57 million, but is expected to go up to 92 million by 2030.