Introduction: Spinal tumors constitute a significant source of morbidity and mortality in the US. The healthcare burden of this disease entity has yet to be elucidated. We analyzed trends in the surgical treatment of metastatic spinal tumors and assessed the socioeconomic impact on a national level.

Methods: Data were abstracted from the Nationwide Inpatient Sample (NIS) for 2001-2009. The NIS represents a 20% random stratified sample of all discharges from non-federal hospitals within the United States. Patients with “secondary malignancies” and “pathological fractures” who underwent spinal fusion were identified using the appropriate ICD-9-CM codes. The number of discharges, length of stay (LOS), hospital charges, and total national charges were analyzed.

Results: During this 9-year period, there has been a 124% increase in the number of spinal fusions for metastatic spinal tumors compared to a 71% increase in spinal fusions for all conditions combined. Average hospital charges per admission and mean LOS are 2 and 3 times as high for spinal tumors, respectively, as they are for all conditions combined. In addition, there has been a 31% increase in the ratio of spinal tumor fusions to total spinal fusions over this same period. According to the most recent data (2009), metastatic spinal tumors represent approximately 1.05% of all spinal fusions, and account for 2.12% of total national spinal fusion charges.

Conclusions: Although spinal tumor fusions represent a small percentage of total spinal fusion procedures on a national level, these cases are associated with higher charges and increased resource utilization. Efforts to decrease hospitalization stays and to make surgical management more cost-effective and efficacious need to continue. High volume referral centers potentially are best equipped to tackle these challenges.

Patient Care: Understanding the socioeconomic burden of spine metastases in our aging population will help spine surgeons to better evaluate the long-term prognosis in the context of clinical decision making and thus provide better care and better patient/care-giver satisfaction.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand the pertinent socioeconomic parameters in the surgical management of spinal metastases in the US. 2) Realize that large nationwide databases are key to performing trend analyses and tracking utilization ratios over time. 3) Identify the importance of patient expectations, life-goals and priorities in the setting of spine metastases prior to offering aggressive surgical management.

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