Introduction
High rates of practice variation in spine surgery likely reflect a poor evidence base. Despite this, spine surgery rates are climbing in Australia, especially in the private sector.
Methods
Using NSW Workers’ Compensation claims data, we identified people who underwent elective spine surgery (fusion, decompression) from 2010 to 2015, inclusive. We calculated rates and outcomes (return to work and reoperation at 1 and 2 years post-surgery).
Results
Among the 6,562 claims included, fusion rates declined from 21 per 100,000 person-years in 2010/11 to 15 in 2014/15. Similarly, decompression rates declined from 29 to 20 per 100,000 person-years over the same period.
Limiting the analysis to lumbar only included 4,604 claims: fusion made up 34%, the mean age was 42 (SD 11) and 75% were male. The median time from injury to surgery was 23 months (interquartile range [IQR]: 9-58) for fusion and 9 (4-25) months for decompression and increased year on year.
Return to work rates (at any capacity) at 1 year were 30% for fusion and 50% for decompression and were unchanged at 2 years. Return to work rates (full capacity) at 1 and 2 years, respectively, were 13% and 18% for fusion, and 33% and 39% for decompression.
Reoperation rates at 1 and 2 years, respectively, were 11% and 17% for fusions, and 13% and 20% for decompressions; some participants underwent up to 4 subsequent surgeries in the first year. For those whose first surgery was a decompression, 55% of subsequent surgeries were decompressions, and 44% were fusions. The most common reoperation following a fusion was a second fusion (78%), while 22% were decompressions.
Conclusion
The rates of spine surgery in the workers’ compensation sector in NSW are decreasing. At 1 and 2 years post-surgery, return to work rates are low and revision surgery rates are high.