10-year development of spine surgery in Germany An analysis of health insurance funds data from 2005 to 2014

Background Analysis of the regional development of spine surgery in Germany between 2005 and 2014. Material and Methods A secondary data analysis of inpatient data from the Scientific Institute of the AOK (WIdO) was carried out for the period 2005 to 2014. The number of spinal procedures was determined on the basis of 14 defined intervention groups (procedures according to OPS codes). The regional numbers of spine surgery procedures in the 402 districts in Germany and the regional age- and gender-standardised distribution are displayed as healthcare utilisation charts. Results 796,870 AOK-insured individuals received inpatient spinal surgery during the observation period. The relative increase in the 10-year period was 82%, with 51,053 interventions in 2005 and 91,971 interventions in 2014. The increase in spine surgery cases occurred mainly between 2005 and 2011. An increase in the number of operations was observed in all intervention groups except excision of intervertebral discs and bones. It was different in different spinal procedures, with the greatest increases in bone decompression (280% increase). Regional differences were found in all intervention groups. In 2014, the number of interventions varied between 109 and 729 interventions per 100,000 AOK-insured individuals in the districts. Conclusion The significant increases of more than 80% in 10 years cannot be explained solely by sociodemographic changes. The pronounced regional differences alone do not allow firm conclusions on the existence of regional underuse, overuse or misuse. The results, however, emphasise the need for further health services research on the quality of the medical indication and the determinants of regional variation.