Unnecessary back surgery is widespread
December 10, 2024
Summary: Unnecessary back surgery is common, leading to increased costs without benefit to patients.
The Lown Institute, a think tank focused on health care reform and value, published research showing that Medicare pays for 200,000 medically unnecessary back surgeries annually, at a cost of $2 billion over three years. They found that 14% of laminectomies and spinal fusions were unnecessary, and rates of inappropriate back surgery range widely from state to state and hospital to hospital. The researchers focused on Medicare because de-identified claims data is publicly available, although the rate of inappropriate laminectomies and spinal fusions in employer-sponsored health insurance is likely to be similarly high.
The Lown researchers also noted that the 3,454 surgeons who performed a measurable number of unnecessary surgeries had received $64 million in payments from medical device makers, suggesting an inappropriate incentive for the surgeons to do these procedures. The researchers did not report on medical device payments received by surgeons who did not do a substantial number of unnecessary procedures. They pointed to three recent reviews that questioned the value of back surgery in many who receive it. (1) (2) (3)
Implications for employers:
Back surgery remains an area of low value care that not only costs tens of thousands per operation but also leaves those treated with implanted hardware that can cause problems later in life.
Access to expert medical opinions can help some members feel comfortable with non-operative choices.
Centers of excellence and surgeons with high volume have better outcomes and may be more likely to discourage surgery in cases where the patient is least likely to benefit.
Alternative treatments, including physical therapy and chiropractic manipulation, can bring pain relief to some of those afflicted with back pain.
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