High volume facilities, surgeons had lower complications, readmissions after lumbar fusion
Click Here to Manage Email Alerts
CHICAGO — Results presented here showed high volume facilities and surgeons had lower complication and readmission rates after lumbar spinal fusion surgery compared with low volume facilities and surgeons.
“It is apparent that not only do high volume surgeons make an impact on patient outcomes, but the hospital where these surgeries are performed also has an impact, likely due to the familiarity of managing these patients perioperatively by nurses, technicians and other physicians involved in the patients’ care,” Christopher McDonald, MD, said in his presentation at the North American Spine Society Annual Meeting. “One of the biggest issues is that the regionalization of care and access to high volume facilities and surgeons further exacerbates health care delivery based on socioeconomic disparities. Identification and awareness of these demographic disparities is crucial to optimize patient care and to elucidate mechanisms for these disparities to be remedied.”
Using the New York Statewide Planning and Research Cooperative System database, McDonald and colleagues identified 16,377 patients who underwent lumbar spinal fusion surgery from 2011 to 2015 at either a high or low volume facility or had surgery performed by a high or low volume surgeon. Researchers used multivariable Cox proportional hazards regression controlling for patient demographic and clinical factors to compare readmission, reoperation, in-hospital mortality and other adverse events between surgeon and facility volumes. Researchers also compared surgeon and facility volumes between the lowest and highest 20% to represent low-volume and high-volume surgeons and facilities.
“Our primary outcome was to identify the risk of complications based on surgeon and facility volumes and our secondary outcome was to identify the role of social deprivation as it relates to surgeon volume and postoperative outcome measures,” McDonald said.
McDonald noted low volume facilities had higher rates of readmission, pneumonia and cellulitis as well as lower rates of deep vein thrombosis at 12-month follow-up. He added low volume surgeons had higher rates of readmission, surgical site infections and wound complications but lower rates of revision surgery.
“Patients who were treated by low volume surgeons and had complications were also more likely to be concentrated to zip codes that had higher levels of social deprivation index,” McDonald said.
Collapse
Brodeur P, et al. Paper 114. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
Read more about
Click Here to Manage Email Alerts