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Evaluation of a Center of Excellence Program for Spine Surgery

Mehrotra, Ateev MD, MPH*,†; Sloss, Elizabeth M. PhD*; Hussey, Peter S. PhD*; Adams, John L. PhD*; Lovejoy, Susan MS*; SooHoo, Nelson F. MD

doi: 10.1097/MLR.0b013e31829b091d
Original Articles

Background: The Centers for Medicare and Medicaid Services and many private health plans are encouraging patients to seek orthopedic care at hospitals designated as centers of excellence. No evaluations have been conducted to compare patient outcomes and costs at centers of excellence versus other hospitals. The objective of our study was to assess whether hospitals designated as spine surgery centers of excellence by a group of over 25 health plans provided higher quality care.

Methods: Claims representing approximately 54 million commercially insured individuals were used to identify individuals aged 18–64 years with 1 of 3 types of spine surgery in 2007–2009: 1-level or 2-level cervical fusion (referred to as cervical simple fusion), 1-level or 2-level lumbar fusion (referred to as lumbar simple fusion), or lumbar discectomy and/or decompression without fusion. The primary outcomes were any complication (7 complications were captured) and 30-day readmission. The multivariate models controlled for differences in age, sex, and comorbidities between the 2 sets of hospitals.

Results: A total of 29,295 cervical simple fusions, 27,214 lumbar simple fusions, and 28,911 lumbar discectomy/decompressions were identified, of which 42%, 42%, and 47%, respectively, were performed at a hospital designated as a spine surgery center of excellence. Designated hospitals had a larger number of beds and were more likely to be an academic center. Across the 3 types of spine surgery (cervical fusions, lumbar fusions, or lumbar discectomies/decompressions), there was no difference in the composite complication rate [OR 0.90 (95% CI, 0.72–1.12); OR 0.98 (95% CI, 0.85–1.13); OR 0.95 (95% CI, 0.82–1.07), respectively] or readmission rate [OR 1.03 (95% CI, 0.87–1.21); OR 1.01 (95% CI, 0.89–1.13); OR 0.91 (95%, CI 0.79–1.04), respectively] at designated hospitals compared with other hospitals.

Conclusions: On average, spine surgery centers of excellence had similar complication rates and readmission rates compared with other hospitals. These results highlight the importance of empirical evaluations of centers of excellence programs.

Supplemental Digital Content is available in the text.

*RAND Corporation

Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

RAND Corporation has an unrestricted license to publish this article; the copyright owner has asserted its contractual right to remain unnamed. Published with permission of the RAND Corporation.

This work was funded by the creator of this center of excellence program, which prefers to remain anonymous, while recognizing the authors' right to publish this manuscript independently.

A.M. was supported by a career development award from the NIH (KL2-RR024154-01).

The authors declare no conflict of interest.

Reprints: Ateev Mehrotra, MD, MPH, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665. E-mail:

© 2013 by Lippincott Williams & Wilkins.