Abstract
BACKGROUND: Lumbar spine disorders are a major contributor to disability and healthcare utilization worldwide, particularly in aging populations. Over the past two decades, significant changes have occurred in surgical techniques for managing lumbar spine disorders. This study aims to provide a comprehensive analysis of hospitalization trends for lumbar disc herniation and intervertebral disc degeneration in the Italian population from 2001 to 2022. METHODS: This nationwide retrospective study used data from the national hospital discharge (NHD) database managed by the Italian Ministry of Health. All patients hospitalized for surgical treatment of lumbar disc degeneration during the 22-year period were included. Age- and sex- standardized hospitalization rates (SHRs) were calculated using direct standardization. Poisson regression identified factors associated with length of hospital stay. Interregional mobility was analyzed as the percentage of hospitalizations in each region relative to its resident population. RESULTS: Between 2001 and 2022, 621,948 patients (57.4% male, 42.9% aged 45-64 years) underwent surgical treatment for lumbar disc degeneration. Age-sex SHRs declined from 57.41 to 49.43 per 100,000, peaking at 66.38 in 2004. Average hospital stay decreased from 6.4 in 2001 to 3.0 days in 2022. Longer stays were observed in patients ≥ 75 years (IRR = 1.070; 95% CI: 1.011-1.132), in Southern Italy (IRR = 1.199; 95% CI: 1.174-1.225) or the Islands (IRR = 1.165; 95% CI: 1.136-1.195), and in patients undergoing fusion surgery (IRR = 1.905; 95% CI: 1.873-1.938). Admission to private institutions was associated with 25.7% shorter stays (IRR = 0.743, 95% CI: 0.726-0.755). Decompression procedures peaked at > 32,000 cases in 2004 and declined to around 20,000 by 2022, fusion surgeries steadily increased to > 5,700 cases, and arthroplasty, introduced in 2009, remained < 60 cases annually. Several regions reported > 80% of residents hospitalized locally, along with substantial interregional patient flows. CONCLUSIONS: This study provides a comprehensive overview of lumbar spine management trends in Italy. Over 22 years, surgeries shifted from decompression to fusion, hospital stays decreased, and length of stay was influenced by age, region, surgical type, and institution. Regional disparities and patient mobility reflect differences in healthcare access. These findings highlight evolving surgical practices and can inform future planning in spinal care management.