Impact of the Economic Downturn on Elective Cervical Spine Surgery in the United States: A National Trend Analysis, 2003-2013

Abstract Objective To analyze overall trends of elective cervical spine surgery in the United States from 2003-13 with the goal of determining whether the economic downturn had an impact. Methods Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) were used in order to identify elective cervical spine surgery procedures in the Nationwide Inpatient Sample (NIS) from 2003-13. National Health Expenditure, Gross Domestic Product (GDP) and Standard and Poor’s (S&P) 500 Index were used as measures of economic performance. The economic downturn was defined as 2008-09. Confidence intervals were determined using subgroup analysis techniques. Linear regressions were completed to determine the association between surgery trends and economic conditions. Results From 2003-13, posterior cervical fusions saw a 102.7% increase. During the same timeframe, there was a 7.4% and 14.7% decrease in the number of anterior cervical discectomy and fusions (ACDFs) and posterior decompressions, respectively. The trend of elective cervical spine surgeries per 100,000 persons in the U.S. population may have been affected by the economic downturn from 2008-09 (-0.03% growth). The percentage of procedures paid for by private insurance decreased from 2003-13 for all ACDF, posterior cervical fusion and posterior decompression. The linear regression coefficients (β) and R2 values between the number of surgeries and each of the macroeconomic factors analyzed were not statistically significant. Conclusions The overall elective cervical spine surgery trend was not likely impacted by the economic downturn. Posterior cervical fusions grew significantly from 2003-2013, while ACDFs and posterior decompressions decreased.