TY - JOUR
T1 - The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis
AU - Dasenbrock, Hormuzdiyar H.
AU - Clarke, Michelle J.
AU - Witham, Timothy F.
AU - Sciubba, Daniel M.
AU - Gokaslan, Ziya L.
AU - Bydon, Ali
PY - 2012/6
Y1 - 2012/6
N2 - Background: Investigation into the provider volume-outcomes association for patients undergoing spine surgery has been limited. Objective: To examine the impact of surgeon and hospital volume on the outcomes after decompression with or without fusion for lumbar spinal stenosis. Methods: Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Multivariate logistic regression analyses were performed to calculate the adjusted odds of in-hospital mortality and the development of a postoperative complication with increasing surgeon or hospital volume. Provider volume was evaluated continuously and categorically, divided by percentiles into quintiles. Very-low-volume surgeons performed < 15 procedures over 4 years. All analyses were adjusted for differences in patient age, sex, comorbidities, and primary payer, as well as hospital bed size, teaching status, and location (urban vs rural). Results: A total of 48 971 admissions were examined. In-hospital mortality did not differ significantly with increasing provider volume. When examined continuously, greater surgeon volume was associated with a significantly lower adjusted odds of developing a complication (odds ratio, 0.72; 95% confidence interval, 0.65-0.78; P < .001). Patients who underwent surgery by very-low-volume surgeons (odds ratio, 1.38; 95% confidence interval, 1.19-1.60; P = .001), but not those treated by low-, medium-, or high-volume surgeons, had a significantly higher complication rate compared with those who underwent surgery by very high-volume surgeons. After adjustment for surgeon volume, hospital volume was not significantly associated with in-hospital mortality or complications. Conclusion: In this nationwide study, patients treated by very-low-volume surgeons had a significantly higher complication rate compared with those treated by very high-volume surgeons.
AB - Background: Investigation into the provider volume-outcomes association for patients undergoing spine surgery has been limited. Objective: To examine the impact of surgeon and hospital volume on the outcomes after decompression with or without fusion for lumbar spinal stenosis. Methods: Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Multivariate logistic regression analyses were performed to calculate the adjusted odds of in-hospital mortality and the development of a postoperative complication with increasing surgeon or hospital volume. Provider volume was evaluated continuously and categorically, divided by percentiles into quintiles. Very-low-volume surgeons performed < 15 procedures over 4 years. All analyses were adjusted for differences in patient age, sex, comorbidities, and primary payer, as well as hospital bed size, teaching status, and location (urban vs rural). Results: A total of 48 971 admissions were examined. In-hospital mortality did not differ significantly with increasing provider volume. When examined continuously, greater surgeon volume was associated with a significantly lower adjusted odds of developing a complication (odds ratio, 0.72; 95% confidence interval, 0.65-0.78; P < .001). Patients who underwent surgery by very-low-volume surgeons (odds ratio, 1.38; 95% confidence interval, 1.19-1.60; P = .001), but not those treated by low-, medium-, or high-volume surgeons, had a significantly higher complication rate compared with those who underwent surgery by very high-volume surgeons. After adjustment for surgeon volume, hospital volume was not significantly associated with in-hospital mortality or complications. Conclusion: In this nationwide study, patients treated by very-low-volume surgeons had a significantly higher complication rate compared with those treated by very high-volume surgeons.
KW - Hospital volume
KW - Lumbar decompression
KW - Lumbar fusion
KW - Lumbar spinal stenosis
KW - Nationwide Inpatient Sample
KW - Provider volume
KW - Surgeon volume
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U2 - 10.1227/NEU.0b013e318251791a
DO - 10.1227/NEU.0b013e318251791a
M3 - Article
C2 - 22610361
AN - SCOPUS:84861495532
SN - 0148-396X
VL - 70
SP - 1346
EP - 1353
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -