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doi: 10.1227/NEU.0b013e318251791a
Research-Human-Clinical Studies: Editor's Choice

The Impact of Provider Volume on the Outcomes After Surgery for Lumbar Spinal Stenosis

Dasenbrock, Hormuzdiyar H. MD*; Clarke, Michelle J. MD; Witham, Timothy F. MD§,¶,‖; Sciubba, Daniel M. MD§,¶,‖; Gokaslan, Ziya L. MD§,¶,‖; Bydon, Ali MD§,¶,‖

Editor's Choice
CNS University of Neurosurgery
Press Release
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BACKGROUND: Investigation into the provider volume-outcomes association for patients undergoing spine surgery has been limited.

OBJECTIVE: To examine the impact of surgeon and hospital volume on the outcomes after decompression with or without fusion for lumbar spinal stenosis.

METHODS: Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Multivariate logistic regression analyses were performed to calculate the adjusted odds of in-hospital mortality and the development of a postoperative complication with increasing surgeon or hospital volume. Provider volume was evaluated continuously and categorically, divided by percentiles into quintiles. Very-low-volume surgeons performed < 15 procedures over 4 years. All analyses were adjusted for differences in patient age, sex, comorbidities, and primary payer, as well as hospital bed size, teaching status, and location (urban vs rural).

RESULTS: A total of 48 971 admissions were examined. In-hospital mortality did not differ significantly with increasing provider volume. When examined continuously, greater surgeon volume was associated with a significantly lower adjusted odds of developing a complication (odds ratio, 0.72; 95% confidence interval, 0.65-0.78; P < .001). Patients who underwent surgery by very-low-volume surgeons (odds ratio, 1.38; 95% confidence interval, 1.19-1.60; P = .001), but not those treated by low-, medium-, or high-volume surgeons, had a significantly higher complication rate compared with those who underwent surgery by very high-volume surgeons. After adjustment for surgeon volume, hospital volume was not significantly associated with in-hospital mortality or complications.

CONCLUSION: In this nationwide study, patients treated by very-low-volume surgeons had a significantly higher complication rate compared with those treated by very high-volume surgeons.

ABBREVIATIONS: CI, confidence interval

ICD-9-CM, International Classification of Diseases, 9th revision, clinical modification

NIS, Nationwide Inpatient Sample

OR, odds ratio

Copyright © by the Congress of Neurological Surgeons


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