Unnecessary Back Surgeries on Older Patients Lead to Adverse Complications: Report

More than half of back surgeries at some hospitals were performed without clear medical need, putting patients at risk of serious complications.

A new report warns that dozens of U.S. hospitals are performing spinal surgeries on older patients without clear medical justification, leading to serious complications such as infections, blood clots and strokes.

According to findings published this month in the Lown Institute Hospitals Index’s report on Unnecessary Back Surgery, more than 200,000 back operations were performed on Medicare patients from 2020 to 2023, often providing little relief while leaving thousands to deal with serious post-surgical complications.

The Lown Institute Hospitals Index measures hospitals’ social responsibility by evaluating quality of care, patient outcomes and health equity. The independent nonprofit aims to hold the healthcare system accountable and promote fair, effective treatment for all patients.

The group’s Unnecessary Back Surgery report examined hospital use of spinal fusion, laminectomy and vertebroplasty procedures, which are major surgeries typically reserved for specific conditions, since they are often linked to serious side effects. Researchers found that dozens of hospitals performed these operations far more often than medically justified.

Using Medicare fee for service 2021-2023 and Medicare Advantage 2020-2022 claims data, Lown Institute researchers concluded there was one unnecessary back procedure conducted every eight minutes, costing Medicare more than $1.9 billion over three years. In total, there were nearly 10,000 unnecessary back surgeries done in each state across the study period.

Overall, 18% of patients experienced complications, including infections, blood clots, stroke, unplanned hospital admissions, pneumonia, heart and lung problems, and death. In some cases, patients endured these side effects even though the surgeries were unsuccessful in treating their back problems.

Spinal fusion/laminectomy procedures fuse the vertebrae together or remove part of the vertebrae. They are often done together and are typically recommended for patients with low back pain from traumatic injury, sciatica, slipped spinal bone or spinal deformities. However, researchers concluded that patients with pain from aging often don’t experience relief, while doctors still recommend and perform these surgeries.

Vertebroplasty treats spinal fractures caused by osteoporosis, bone cancer and other conditions. Doctors inject a medical grade cement into the fracture through a needle. The cement hardens in the bone space to form an internal cast. However, anywhere from 5 to 10% of patients experience complications, including cement leakage.

The highest rates of side effects from either spinal fusion or vertebroplasty included failed back surgery at 40%, safety incidents (10%), and cement leakage (8%). The average spinal fusion surgery overuse rate across U.S. hospitals was 13%. The hospitals with the highest overuse rates included Mount Nittany Medical Center in Pennsylvania at 57%, and Concord Hospital in New Hampshire at 40%.

The average vertebroplasty overuse rate across the U.S. was 10%, while the highest overuse rates were 56% at Kettering Health Miamisburg, 55% at Shannon Medical Center Texas, and 50% at St. Elizabeth Florence Hospital Kentucky.

The procedures cost Medicare nearly $2 billion over three years, with each spinal fusion costing an average of $14,500 and each vertebroplasty costing an average of $4,200, the researchers concluded.

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