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Variability in elective spine surgery is high throughout Californian referral areas, study finds

Issue: December 2011

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CHICAGO — Elective spine surgery varies heavily between referral areas in California and is consistent with the variability found in other areas of the United States, according to a study presented by Sigurd H. Berven, MD, at the 2011 Annual Meeting of the North American Spine Society .

“Invariability in surgical rates is an important factor, both in measuring quality of care and also in predicting consistent costs of care,” Berven said during his presentation. “Variability in spine surgery rates reveals the absence of an evidence-based approach. High rates in variability demonstrate that patient care is based upon preference rather than evidence.”

Berven and colleagues performed a descriptive study, using data from the Office of Statewide Health Planning and Development to identify patient discharge data for 234,899 elective procedures performed between 2005 and 2009 — with a denominator of more than 131 million person years. With an outcome measure of lumbar spine surgery rates found in hospital service areas (HSAs) and hospital referral regions (HRRs), the team adjusted for variables such as age, gender, income, education level, insurance status and race. Procedures analyzed in the study included cervical, thoracic and lumbar degenerative conditions performed on patients older than 20 years.

According to Berven, elective spine surgery occurred at a rate of 166 cases per 100,000 population. The team found a surgical rate ratio in high-volume HRRs — 2.05 times higher than that found in low-volume HRRs. Variability in those rates among HSAs is “much higher,” Berven noted, with a ratio of 11.3. High- and low-volume HRRs, Berven said, saw a higher contrast of ratios for other common orthopedic procedures.

Berven noted that while the variability of degenerative spine disorder management treatment could be minimized through an evidence-based approach, the actual rate of these treatments will likely not decrease.

“We do not know what the ‘right’ rate of surgery is, but if we can minimize variability, we can do a much better job of predicting costs,” he concluded. “An evidence-based approach of managing degenerative spinal disorders can minimize variability in surgical rates … When we minimize variability, that implies better quality and much more consistent and predictable costs.”

Reference:

• Berven SH, Bederman SS, Deyo R, et al. Regional variation in rates of elective spine surgery in California: A report on effective patient care. Paper #146. Presented at the 2011 Annual Meeting of the North American Spine Society. Nov. 2-5. Chicago.
• Disclosure: Berven receives royalties from Medtronic, has ownership of Baxano, AccuLIF and Simpirica Spine, is a consultant for Medtronic, Orthovita and Biomet, is a member of the scientific advisory board for Medtronic Spine and receives grants from Medtronic.

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