Hospital and Surgeon Variation in Complications and Repeat Surgery Following Incident Lumbar Fusion for Common Degenerative diagnoses
Published Date:Jun 20 2012
Source:Health Serv Res. 48(1):1-25.
Aged, 80 And Over
Length Of Stay
Severity Of Illness Index
Pubmed Central ID:PMC3465627
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
To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery.
Discharge registry including all non-federal hospitals in Washington State from 2004–2007.
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.
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.
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.
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