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

Details

• Alternative Title:
  Health Serv Res
• Personal Author:
  Martin, Brook I. ; Mirza, Sohail K. ; Franklin, Gary M. ; Lurie, Jon D. ; MacKenzie, Todd A. ; Deyo, Richard A.
• 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 non-federal hospitals in Washington State from 2004–2007.
  
  Study Design
  
  We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether or not 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% of patients, and 2.2% had a reoperation. Hospital effects accounted for 8.8% of the total variability, and surgeon effects account for 14.4%. Surgeon-factors account for 54.5% of the variation in hospital reoperation rates, and 47.2% 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% 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.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Age Factors Comorbidity Female Hospital Administration Humans Length Of Stay Lumbar Vertebrae Male Medical Assistance Middle Aged Neurodegenerative Diseases Orthopedics Patient Safety Postoperative Complications Quality Improvement Reoperation Severity Of Illness Index Sex Factors Spinal Fusion Time Factors

  More +
• Source:
  Health Serv Res. 48(1):1-25.
• Pubmed ID:
  22716168
• Pubmed Central ID:
  PMC3465627
• Document Type:
  Journal Article
• Funding:
  5R21CE001850-02/CE/NCIPC CDC HHS/United States ; R01 AR054912/AR/NIAMS NIH HHS/United States ; RC1 AG036268/AG/NIA NIH HHS/United States
• Place as Subject:
  Washington
• Volume:
  48
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:db94147d275541231099aa9308b35a975315858ba22ff49851e7e10a2ec94b94
• Download URL:
  https://stacks.cdc.gov/view/cdc/33442/cdc_33442_DS1.pdf
• File Type:
  [PDF - 374.10 KB ]