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. 2024 Aug 9;5(8):662-670.
doi: 10.1302/2633-1462.58.BJO-2024-0026.R1.

Trends, costs, and complications associated with after-hours surgery and unscheduled hospitalization in spinal surgery

Tomoyuki Tanaka  1 , Masanao Sasaki  2 , Junya Katayanagi  1 , Akihiko Hirakawa  2 , Kiyohide Fushimi  3 , Toshitaka Yoshii  4 , Tetsuya Jinno  1 , Hiroyuki Inose  1   4
Affiliations

Trends, costs, and complications associated with after-hours surgery and unscheduled hospitalization in spinal surgery

Tomoyuki Tanaka et al. Bone Jt Open. .

Abstract

Aims: The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs.

Methods: We retrospectively investigated data extracted from the Diagnosis Procedure Combination database, a representative inpatient database in Japan. The data from April 2010 to March 2020 were used for this study. We included all patients who had undergone any combination of laminectomy, laminoplasty, discectomy, and/or spinal arthrodesis.

Results: This investigation included 739,474 spinal surgeries and 739,215 hospitalizations in Japan. There was an average annual increase of 4.6% in the number of spinal surgeries. Scheduled hospitalizations increased by 3.7% per year while unscheduled hospitalizations increased by 11.8% per year. In-hours surgeries increased by 4.5% per year while after-hours surgeries increased by 9.9% per year. Complication rates and costs increased for both after-hours surgery and unscheduled hospitalizations, in comparison to their respective counterparts of in-hours surgery and scheduled hospitalizations.

Conclusion: This study provides important insights for those interested in improving spine care in an ageing society. The swift surge in after-hours spinal surgeries and unscheduled hospitalizations highlights that the medical needs of an increasing number of patients due to an ageing society are outpacing the capacity of existing medical resources.

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Conflict of interest statement

H. Inose reports that until March 2023, his department was receiving funding for operating costs from Medtronic and Stryker, which is unrelated to this work.

Figures

Fig. 1
Fig. 1
a) Scatter plots with lines demonstrating the total number of spinal surgeries in Japan from 2010 to 2019. The grey line indicates trend line. b) Trends in the age distribution of patients who underwent spine surgery in Japan from 2010 to 2019.
Fig. 2
Fig. 2
Scatter plots with lines demonstrating the total number of scheduled hospitalizations and unscheduled hospitalizations in Japan from 2010 to 2019. The grey lines indicate the respective trend lines.
Fig. 3
Fig. 3
Scatter plots with lines demonstrating the total number of in-hours surgeries and after-hours surgeries in Japan from 2010 to 2019. The grey lines indicate the respective trend lines.
See this image and copyright information in PMC

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