Study authors examined 17,997 patients who underwent surgery for lumbar herniated intervertebral disc disease as well as 38,264 patients who underwent surgery in 2008. The patients either underwent open discectomy, fusion, laminectomy or percutaneous endoscopic lumbar discectomy. The researchers found:
1. The number of surgeries increased 2.13-fold from 2004 to 2008, and the number of hospitals performing the procedures was up 34.7 percent over that time period.
2. Midsized hospitals — those with 30 to 300 beds — performing the procedure increased from 62.8 percent in 2003 to 70.86 percent in 2008; however the surgeries performed at those hospitals increased by a greater percentage: 61.31 percent to 85 percent.
3. Reoperation probability for each procedure was calculated as:
• Laminectomy: 10.7 percent
• Open discectomy: 10.5 percent
• Percutaneous endoscopic lumbar discectomy: 9.2 percent
• Fusion: 7.5 percent
4. The endoscopic procedure was cost-effective, according to the incremental cost-effectiveness ratio.
5. From 2003 to 2008, open discectomy proportions increased from 71.21 percent to 84.12 percent while the endoscopic procedure proportion decreased from 16.68 percent to 4.57 percent.
“The choice of surgical method might not always be consistent with cost-effectiveness strategies, and a high proportion of medium-sized hospitals may be responsible for this change,” concluded the study authors.
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