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Study: Spine care at centers of excellence no different than other programs
Hospitals designated as centers of excellence offered no significant difference in overall spine care.
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Surgical costs and rates of reoperations and major operative complications were no different at hospitals designated as centers of excellence than at undesignated hospitals, according to research presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
“[There is] a trend here towards a slightly higher rate at other hospitals compared to centers of [excellence] for the reoperation rate, but it is very important to note that none of these differences are statistically significant,” Nelson F. SooHoo, MD, of Los Angeles, said.
In a Blue Cross/Blue Shield Association-funded study, SooHoo and colleagues retrospectively analyzed claims from 54 million enrollees of a large health insurer association during an 18-month period. Comparing between hospitals designated as centers of excellence and those hospitals that were not, they included 1- or 2-level simple lumbar fusion with an anterior or posterior approach, lumbar discectomy and/or decompression without fusion, and simple cervical fusion procedures in their analysis, according to the abstract.
Need for validation
For the procedures analyzed, the researchers included 369 centers of distinction and 1,449 undesignated hospitals, comparing rates of all-cause readmission within 30 days of discharge, costs within 90 days of the procedure, and composite complication rates including reoperation, according to the abstract.
Using a regression analysis, SooHoo and colleagues adjusted their results for 26 inpatient and outpatient-coded comorbidities as well as other patient characteristics such as age and gender.
They found none of the main outcome measures were statistically significantly different, SooHoo, an Orthopedics Today Editorial Board member, noted.
More than one-third of each surgical procedure analyzed occurred at a designated center, with 42% of the 29,295 patients who had a cervical fusion, 42% of the 27,214 patients who had a lumbar fusion, and 47% of the 28,911 patients who had a lumbar discectomy and/or decompression having them performed at a designated center of excellence.
Limitations of study
Based on the conclusion, health care providers should not be so quick to recommend patients to centers of excellence without first conducting a systematic assessment of criteria used to designate these centers, SooHoo said. “This study really highlights the importance of validation of criteria before implementation of centers of excellence programs, particularly if insurers are going to direct their beneficiaries away from other hospitals,” he said.
According to the findings, designated hospitals were more likely to be academic hospitals and have a higher inpatient volume.
Study limitations included the inability to adjust for the severity of spine disease and being unable to access functional improvement and pain outcomes due to the limited data in the claims database, SooHoo said. – by Jeff Craven
Reference:
- SooHoo NF, Mehrotra A, Sloss E, et al. Evaluation of a center of excellence program for spine surgery. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb 7-11, 2012. San Francisco.
For more information:
- Nelson F. SooHoo, MD, can be reached at UCLA Department of Orthopaedic Surgery, 10945 Le Conte Ave #33-55, Los Angeles, CA 90095; 310-267-5299; email: nsoohoo@mednet.ucla.edu.
- Disclosure: The study was funded by the Blue Cross/Blue Shield Association.
Perspective
Back to TopAlex J. Ghanayem, MD
A spine surgery “center of excellence” — how does one get this blue ribbon label? What is the implication for patients, physicians, health systems and, of course, payers? The most important issue is that of patient care. SooHoo and colleagues attempted to answer that question in their study presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting by evaluating millions of data points yielding complication and re-admission rates as well as cost for nearly 90,000 patients undergoing 1- or 2-level cervical or lumbar fusion, or a lumbar decompression procedure. The results showed no difference in complication rates, readmissions and cost.
The most important outcome, however, was not measured — how well the patient did from a pain reduction and functional improvement perspective. So for now, the “center of excellence” label has no demonstrable benefits in the surgical treatment of spinal disorders. So perhaps, the process by which one receives the center designation needs to encompass patient center outcome and value data to have validity beyond a label.
Perspective
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Jack M. Bert, MD
Based upon the presentation abstract, the conclusion drawn is that “centers of excellence” as determined by the Blue Cross/Blue Shield association have results similar to other hospital systems that are not designated as “centers of excellence.” The real question is, what makes a hospital or surgery center a “center of excellence” if complication rates and readmission rates are similar between institutions. The answer may simply be that the overwhelming majority of surgeons are well trained and outstanding care is offered wherever the surgical procedures are performed.
Unfortunately, system defects within hospital systems can result in complications whether they are infections or poor outcomes not necessarily related to surgical technique or implant failures. Thus, with a high-powered study such as this, it is difficult to conclude that “centers of excellence” truly exist or are evidence based. As long as the surgeons are well educated and well trained, it would appear that the majority of hospitals are “centers of excellence.”
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