Surgeon experience affects complication rate of spinal stenosis surgery

Complication risk for the operative treatment of spinal stenosis is higher when the surgeon performing the intervention performs fewer than four per year, according to a recent study.

“For patients undergoing surgery for lumbar spinal stenosis, the individual surgeon’s experience, skill and clinical knowledge may be key determinants of outcomes, whereas hospital resources may be of secondary importance,” lead author Ali Bydon, MD, and his team wrote in the study published in Neurosurgery.

Bydon’s team retrospectively extracted data from the Nationwide Inpatient Sample from 2005 to 2008, investigating the odds of in-hospital mortality and postoperative complication development when taking into account increasing surgeon or hospital volume. Surgeons who performed fewer than 15 procedures during a 4-year span were defined as being very low-volume, while those who performed more than 81 during that same span were defined as being very high-volume.

Patient age, sex, comorbidities and the primary payer were all factored into the analysis, according to the study abstract, with hospital bed size, teaching status and urban vs. rural location also taken into account.

In all, 48,971 admissions were investigated. An increase in provider volume did not cause in-hospital mortality to differ significantly, but the authors found greater surgeon volume to be associated with significantly lower adjusted odds for complication development.

Patients of very low-volume surgeons, the authors found, displayed significantly higher complication rates when compared to patients of very high-volume surgeons. Following adjustments, risk was found to be 38% higher for patients of very low-volume surgeons. Surgeons at intermediate levels, the authors wrote, did not display any significant increases in risk.

Hospital volume, when adjusted for surgeon volume, was not found to be significantly associated with complications or in-hospital mortality.

The authors also noted that more than 40% of higher-volume surgeons did not work at large, university hospitals — with many working at smaller or rural hospitals.

“Therefore, the resources of a large academic medical center or a large, urban hospital may not be necessary for a high-volume spine surgeon,” they wrote.

Reference:

Hormuzdiyar D, Clarke M, Witham T, et al. The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis. Neurosurgery. 2012. doi:10.1227/NEU.0b013e318251791a