Hospital and Surgeon Variation in Complications and Repeat Surgery Following Incident Lumbar Fusion for Common Degenerative Diagnoses

Details

• Personal Author:
  Deyo RA ; Franklin GM ; Lurie JD ; MacKenzie TA ; Martin BI ; Mirza SK
• Description:
  Objective: To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. Data Sources: Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007. Study Design: We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random effects were used to examine complications, controlling for patient characteristics and comorbidity. Principal Findings: Complications within 90 days of a fusion occurred in 4.8 percent of patients, and 2.2 percent had a reoperation. Hospital effects accounted for 8.8 percent of the total variability, and surgeon effects account for 14.4 percent. Surgeon factors account for 54.5 percent of the variation in hospital reoperation rates, and 47.2 percent of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of bone morphogenetic proteins, accounted for 30 and 50 percent of the variation in surgeons' reoperation and complication rates, respectively. Conclusions: To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons' discretionary use of operative techniques may be more effective than those that target hospitals. [Description provided by NIOSH]
• Subjects:
  Occupational Health Safety
• Keywords:
  Author Keywords: Lumbar Back Pain Complications Fusion Low Back Disorders Medical Treatment Repeat Surgery Safety Spine Surgery Surgery
• ISSN:
  0017-9124
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  New Hampshire ; Oregon ; OSHA Region 1 ; OSHA Region 10 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-25
• Volume:
  48
• Issue:
  1
• NIOSHTIC Number:
  nn:20056923
• Citation:
  Health Serv Res 2013 Feb; 48(1):1-25
• Contact Point Address:
  Brook I. Martin, Ph.D., M.P.H., The Geisel School of Medicine at Dartmouth and the Department of Orthopaedics at Dartmouth-Hitchcock Medical Center, One Medical Center Drive, HB 7541, Lebanon, NH 03756-0001
• Email:
  Brook.I.Martin@Dartmouth.edu
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Health Services Research
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:7282134d5a85f666f7de8c715bead15d3de9e0e384db0bb4a9f08c011e5676df4785fd069bd2b643f7a6c1362a1d99cc838171afe10b58d63ccc47b0b5eac477
• Download URL:
  https://stacks.cdc.gov/view/cdc/214416/cdc_214416_DS1.pdf
• File Type:
  [PDF - 221.91 KB ]