Factoid

Striking little fact from an interesting tale of kickbacks for spinal fusion surgery in the WSJ:

In California, this trend shows up in the workers' compensation system. California employers paid $7.1 billion in insurance premiums to cover their workers' compensation liability in 2010. Spinal-fusion surgery is a growing part of the care these premiums pay for. It accounted for 40% of inpatient hospital charges to the state workers' compensation system in 2010, up from 30% in 2001, a Journal analysis of hospital discharge data shows.

It’s striking that there was such an increase in spinal fusion surgery—a New England Journal of Medicine article noted that the incidence of such surgery went up 77% nationally from 1996 to 2001. Obviously it’s not a perfect match here, but to follow up a five-year period of bumper increases with yet more bumper increases is pretty interesting.

Spinal fusion surgeries are controversial. That same NEJM article I linked to earlier makes a case for restraint; an article whose authors wrote the evidence-based guidelines for lumbar fusion basically throws up its hands and says “Uh, we don’t know” and practices general skepticism towards all other attempts to figure it out. (This review of European studies shows results anywhere from “appallingly expensive” to “somewhat expensive.”)