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Read Original Story

Study: Riskier surgeries for back pain raise costs


5 Star

Study: Riskier surgeries for back pain raise costs

Our Review Summary

Thorough report, including a glance at how marketing and financial conflict of interest may have influenced the rise in costly, complex surgeries.


Why This Matters

The story ends with an important quote from a spine surgeon:  "Too much fusion surgery is done in this country and often for inappropriate reasons" and patients "should not hesitate to get a second opinion."


Does the story adequately discuss the costs of the intervention?


The story deal with cost very early in the story: 

"You have one kind of operation that could cost $20,000 and another that could cost $80,000 and there’s not good evidence the expensive one is being used appropriately in the majority of cases"…

Add to that the expense for patients whose problems after surgery send them back to the hospital or to a nursing home and "that’s not a trivial amount of money" for Medicare…

The cost to Medicare, just for the hospital charges for the three types of back surgery reviewed is about $1.65 billion a year, according to the researchers.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?


The story clearly stated, "The study didn’t address how successful the various types of surgeries were at relieving pain."

Does the story adequately explain/quantify the harms of the intervention?


Good job using absolute risk data: 

About 5 in 100 patients who had simple or complex fusions suffered major complications such as stroke compared to 2 in 100 with decompressions. The risk of death within 30 days after surgery was different too: 6 in 1,000 for complex fusions compared with 5 in 1,000 for simple fusions and 3 in 1,000 for decompressions.

Does the story seem to grasp the quality of the evidence?


Nice job emphasizing what’s known and what’s not known.  Excerpts: 

There’s little agreement about the best way to treat chronic lower back pain, and much depends on what’s causing the pain.

The study didn’t address how successful the various types of surgeries were at relieving pain.

"It certainly looks like there’s more complex surgery being done than we have very good evidence to support," Carragee said.

Rates of complex fusions in Medicare patients rose 15-fold from 2002 to 2007, while decompressions and simple fusions declined, the study found. Although the overall procedure rate fell, hospital charges grew 40 percent.

Does the story commit disease-mongering?


This story is almost the opposite of disease-mongering.

Does the story use independent sources and identify conflicts of interest?


The lead researcher, an editorial writer, and an independent expert were quoted.

Does the story compare the new approach with existing alternatives?


The story refers to alternatives: 

There’s little agreement about the best way to treat chronic lower back pain, and much depends on what’s causing the pain.

Patients should ask their doctors about alternatives to complicated operations, Deyo said. Could steroid injections and physical therapy be tried? Would a simple decompression procedure be as helpful as a spinal fusion and with less risk?

Does the story establish the availability of the treatment/test/product/procedure?


The focus of the story is on the increasing use of "costlier, more complex spinal fusion surgeries." 

Does the story establish the true novelty of the approach?


The novelty was the new data on utilization, which was clearly reported.

Does the story appear to rely solely or largely on a news release?


It’s clear the story did not rely on a news release.

Total Score: 10 of 10 Satisfactory


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