Spines ’R’ Us: The evidence and business behind spinal fusions

Abstract: In Modern Healthcare, Lisa Gillespie reviews the evidence and incentives that drive some hospitals to overuse spinal fusion procedures. She cites research from the Lown Institute in collaboration with Australian academics published this year, which shows that spinal fusions for stenosis and other conditions not backed by strong evidence of effectiveness are associated with poor outcomes. Out of seven low-value procedures, inpatient spinal fusions were affiliated the most with hospital-acquired conditions, adverse patient safety indicators and unplanned hospital admissions after outpatient procedures, their review of Medicare claims from 2016 to 2018 found. “If, on average, this thing doesn’t work, the burden is on you to tell me why for this particular patient, it’s going to work, beyond just a faith-based argument,” said Dr. Vikas Saini, president of the Lown Institute.

“The public expects their doctors to make care decisions, but I will also say the public expects doctors to make their medical decisions on the basis of the best interest of the patient,” Saini said. “It is now going to become more relevant for hospital administrators to do their homework on appropriateness and inappropriateness.”