Carla K. Johnson, AP

A study of Medicare patients shows that costlier, more complex spinal fusion surgeries are on the rise. Findings also suggest these more challenging operations are riskier, leading to more complications and even deaths.

“This is exactly what the health care debate has been dancing around,” said Dr. Eugene Carragee of Stanford University Medical Center. “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,” Carragee said.

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, said Carragee. He wrote an accompanying editorial in the Journal of the American Medical Association where the federally funded study appears.

The cost to Medicare, just for the hospital charges for the three types of back surgery reviewed, is about $1.65 billion a year. All the patients in the study had stenosis in their lower backs. Researchers compared the risks for three different types of surgery for the condition: decompression, simple fusion and complex fusion.

The researchers analyzed data on more than 32,000 Medicare patients who had one of the three types of surgeries in 2007. About five in 100 patients who had simple or complex fusions suffered major complications such as stroke compared to two in 100 with decompressions. The risk of death within 30 days after surgery was different, too: six in 1,000 for complex fusions compared with five in 1,000 for simple fusions and three in 1,000 for decompressions.

The study didn't address how successful the various types of surgeries were at relieving pain. More than half the patients who had complex fusions had a simple stenosis, which usually calls for decompression alone. hey did not have the curvature of the spine or a slipped vertebra — additional conditions that might suggest a fusion is needed. There's not much evidence for doing a complex fusion for a person with simple stenosis, Carragee and other experts said.

“It looks like there's more complex surgery being done than we have good evidence to support,” stated Carragee.