Background: 

Spine surgery has demonstrated cost-effectiveness in reducing pain and restoring function, but the impact of spine surgery relative to nonsurgical care on longer-term outcomes has been less well described. Our objective was to compare single-level surgical treatment for lumbar stenosis, with or without spondylolisthesis, and nonsurgical treatment with respect to patient mortality, resource utilization, and health-care payments over the first 2 years following initial treatment.

Methods: 

A retrospective review of the Medicare National Database Fee for Service Files from 2011 to 2017 was performed. A 2-year prediction of mortality risk (risk stratification index, RSI) was used as a measure of patient baseline health. Patients (88%) were matched by RSI and demographics. Mortality, spine-related health-care utilization, and 2-year total Medicare payments for patients undergoing surgical treatment were compared with matched patients undergoing nonsurgical treatment.

Results: 

We identified 61,534 patients with stenosis alone and 83,813 with stenosis and spondylolisthesis. Surgical treatment was associated with 28% lower 2-year mortality compared with matched patients undergoing nonsurgical treatment. Total Medicare payments were significantly lower for patients with stenosis alone undergoing laminectomy alone and for patients with stenosis and spondylolisthesis undergoing laminectomy with or without fusion compared with patients undergoing nonsurgical treatment. There was no significant difference in mortality when fusion or laminectomy was compared with combined fusion and laminectomy. However, laminectomy alone was associated with significantly lower 2-year payments when treating stenosis with or without spondylolisthesis.

Conclusions: 

Surgical treatment for stenosis with or without spondylolisthesis within the Medicare population was associated with significantly lower mortality and total medical payments at 2 years compared with nonsurgical treatment, although residual confounding could have contributed to these findings.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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与非手术治疗相比，单节段腰椎管狭窄症的手术治疗与较低的 2 年死亡率和总成本相关：风险调整后的配对分析

背景： 

脊柱手术已证明在减轻疼痛和恢复功能方面具有成本效益，但脊柱手术相对于非手术治疗对长期结果的影响却鲜为人知。我们的目标是比较单节段手术治疗腰椎管狭窄症（伴或不伴腰椎滑脱）和非手术治疗在初始治疗后头 2 年的患者死亡率、资源利用率和医疗费用方面的差异。

方法： 

对 2011 年至 2017 年服务文件的 Medicare 国家数据库费用进行了回顾性审查。死亡风险的 2 年预测（风险分层指数，RSI）被用作衡量患者基线健康状况的指标。患者 (88%) 通过 RSI 和人口统计学匹配。将接受手术治疗的患者的死亡率、脊柱相关的医疗保健利用率和 2 年医疗保险总支付额与接受非手术治疗的匹配患者进行比较。

结果： 

我们确定了 61,534 名仅患有狭窄的患者和 83,813 名患有狭窄和脊椎滑脱的患者。与接受非手术治疗的匹配患者相比，手术治疗可使 2 年死亡率降低 28%。与接受非手术治疗的患者相比，仅接受椎板切除术的单纯狭窄患者以及接受融合或不融合椎板切除术的狭窄和脊椎滑脱患者的医疗保险总支付额明显较低。融合或椎板切除术与联合融合和椎板切除术相比，死亡率无显着差异。然而，单独进行椎板切除术治疗伴有或不伴有腰椎滑脱的狭窄时，2 年支付费用显着降低。

结论： 

与非手术治疗相比，在 Medicare 人群中手术治疗伴有或不伴有脊柱滑脱的狭窄与显着降低的死亡率和 2 年时的总医疗费用相关，尽管残余混杂因素可能对这些结果有所贡献。

证据等级： 

治疗三级。有关证据等级的完整描述，请参阅作者须知。