Effect of Surgeon Volume on Complications, Length of Stay, and Costs Following Anterior Cervical Fusion. Issue 6 (15th March 2017)

• Record Type: Journal Article
• Authors: Basques, Bryce A.; Louie, Philip K.; Shifflett, Grant D.; Fice, Michael P.; Mayo, Benjamin C.; Massel, Dustin H.; Guzman, Javier Z.; Bohl, Daniel D.; Singh, Kern
• Is Part Of: Spine. Volume 42:Issue 6(2017)
• Publication Date: 2017-03-15
• Subjects: anterior cervical discectomy and fusion -- anterior cervical fusion -- complications -- cost -- inpatient -- length of stay -- volume; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000001756
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective cohort. Objective: To identify the association between surgeon volume and inpatient complications, length of stay, and costs associated with ACF. Summary of Background Data: Increased surgeon volume may be associated with improved outcomes after surgical procedures. However, there is a lack of information on the effect of surgeon volume on short-term outcomes after anterior cervical fusion (ACF). Methods: A retrospective cohort study of ACF patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Surgeon volume was divided into three categories, volume <25th percentile, 25th to 74th percentile, and ≥75th percentile of surgeon volume. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital costs between surgeon volume categories. Results: A total of 419, 212 ACF patients were identified. The 25th percentile for volume was 5 cases per year, and the 75th percentile for volume was 67 cases per year. Volume <25th percentile was associated with increased rates of any adverse event (odd ratio, OR 3.8, P < 0.001), and multiple individual complications including death (OR 2.5, P =0.014), myocardial infarction (OR4.4, P < 0.001), sepsis (OR 4.1, P < 0.001), and surgical site infection (OR 4.0, P < 0.001). Notably, volume ≥75th percentile was associated with decreased rates of any adverse event (OR 0.7, P < 0.001) and death (OR 0.6, P = 0.028). On multivariate analysis, length of stay was significantly increased by 2.3 days ( P < 0.001) for surgeons <25th percentile of volume and was decreased by 0.3 days for surgeons with volume ≥75th percentile. Hospital costs were $4569 more for surgeons with <25th percentile of volume and $1213 less for surgeons with ≥75th percentile volume. Conclusion: In this nationally representative sample, surgeons with volume <25th percentile had significantly increased complications, length of stay, and costs. Conversely, surgeons with ≥75th percentile volume experienced decreased complications, length of stay, and costs. Level of Evidence: 4