Repeat Surgery After Lumbar Decompression for Herniated Disc: The Quality Implications of Hospital and Surgeon Variation

Details

• Personal Author:
  Deyo RA ; Flum DR ; Heagerty PJ ; Lenkoski AF ; Martin BI ; Mirza SK ; Wickizer TM
• Description:
  Background context: Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates. Purpose: To examine hospital- and surgeon-level variation in reoperation rates after lumbar herniated disc surgery and to relate these to published benchmarks. Study design/setting: Retrospective analysis of a discharge registry including all nonfederal hospitals in Washington State. Methods: We identified adults who underwent an initial inpatient lumbar decompression for herniated disc from 1997 to 2007. We then performed generalized linear mixed-effect logistic regressions, controlling for patient characteristics and comorbidity, to examine the variation in reoperation rates within 90 days, 1 year, and 4 years. Results: Our cohort included 29,529 patients with a mean age of 47.5 years, 61% privately insured, and 15% having any comorbidity. The age-, sex-, insurance-, and comorbidity-adjusted mean rate of reoperation among hospitals was 1.9% at 90 days (95% confidence interval [CI], 1.2-3.1), with a range from 1.1% to 3.4%; 6.4% at 1 year (95% CI, 3.9-10.6), with a range from 2.8% to 12.5%; and 13.8% at 4 years (95% CI, 8.8-19.8), with a range from 8.1% to 24.5%. The adjusted mean reoperation rates of surgeons were 1.9% at 90 days (95% CI, 1.4-2.4) with a range from 1.2% to 4.6%, 6.1% at 1 year (95% CI, 4.8-7.7) with a range from 4.3% to 10.5%, and 13.2% at 4 years (95% CI, 11.3-15.5) with a range from 10.0% to 19.3%. Multilevel random-effect models suggested that variation across surgeons was greater than that of hospitals and that this effect increased with long-term outcomes. Conclusions: Even after adjusting for patient demographics and comorbidity, we observed a large variation in reoperation rates across hospitals and surgeons after lumbar discectomy, a relatively simple spinal procedure. These findings suggest uncertainty about indications for repeat surgery, variations in perioperative care, or variations in quality of care. [Description provided by NIOSH]
• Subjects:
  Occupational Health Safety
• Keywords:
  Author Keywords: Lumbar Spine Surgery Back Pain Decompression Herniated Disc Low Back Disorders Medical Treatment Quality Repeat Surgery Surgery
• ISSN:
  1529-9430
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  New Hampshire ; Ohio ; Oregon ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 5 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  89-97
• Volume:
  12
• Issue:
  2
• NIOSHTIC Number:
  nn:20056922
• Citation:
  Spine J 2012 Feb; 12(2):89-97
• Contact Point Address:
  Brook I. Martin PhD, MPH, Department of Orthopaedics, HB7541, Dartmouth-Hitchcock Medical Center, One Medical Center Dr, Lebanon, NH 03756-0001, USA
• Email:
  Brook.I.Martin@Dartmouth.edu
• Federal Fiscal Year:
  2012
• Performing Organization:
  University of Washington
• Peer Reviewed:
  False
• Start Date:
  20050701
• Source Full Name:
  The Spine Journal
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:f9263953531f330e00650259b6f2420f6e74882ae27b0f763d564c9298b143b649a3e95b5976c18e507cca9ca8a5337048b51a606d67287d8b4483f309a66c30
• Download URL:
  https://stacks.cdc.gov/view/cdc/214415/cdc_214415_DS1.pdf
• File Type:
  [PDF - 495.59 KB ]