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The impact of surgeon volume on patient outcome in spine surgery: a systematic review

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Abstract

Purpose

Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers and adoption of volume standards. With limited literature promoting the regionalization of spine surgeries, we undertook a systematic review to investigate the impact of surgeon volume on outcomes in patients undergoing spine surgery.

Methods

We performed a systematic review examining the association between surgeon volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior cervical discectomy and fusion (ACDF), anterior/posterior cervical fusion, laminectomy/decompression, anterior/posterior lumbar decompression with fusion, discectomy, and spinal deformity surgery (spine arthrodesis).

Results

Studies were variable in defining surgeon volume thresholds. Higher surgeon volume was associated with a significantly lower risk of postoperative complications, a lower length of stay (LOS), lower cost of hospital stay and a lower risk of readmissions and reoperations/revisions.

Conclusions

Findings suggest a trend towards better outcomes for higher volume surgeons; however, further study needs to be carried out to define objective volume thresholds for individual spine surgeries for surgeons to use as a marker of proficiency.

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References

  1. Friedly J, Standaert C, Chan L (2010) Epidemiology of spine care: the back pain dilemma. Phys Med Rehabil Clin N Am 21(4):659–677

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dagenais S, Caro J, Haldeman S (2008) A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 8(1):8–20

    Article  PubMed  Google Scholar 

  3. Deyo RA, Weinstein JN (2001) Low back pain. N Engl J Med 344(5):363–370

    Article  CAS  PubMed  Google Scholar 

  4. Allegri M et al (2016) Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Res 5. https://doi.org/10.12688/f1000research.8105.2

  5. Martin BI et al (2008) Expenditures and health status among adults with back and neck problems. JAMA 299(6):656–664

    Article  CAS  PubMed  Google Scholar 

  6. Weiner DK et al (2006) Low back pain in older adults: are we utilizing healthcare resources wisely? Pain Med 7(2):143–150

    Article  PubMed  Google Scholar 

  7. Deyo RA et al (2005) United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976) 30(12):1441–1445 (discussion 1446–7)

    Article  Google Scholar 

  8. Oglesby M et al (2012) Epidemiological trends in cervical spine surgery for degenerative diseases between 2002 and 2009. Spine (Phila Pa 1976) 38(14):1226–1232

    Article  Google Scholar 

  9. Mehta A et al (2017) Effect of surgeon and hospital volume on emergency general surgery outcomes. J Am Coll Surg 225(5):666–675

    Article  PubMed  Google Scholar 

  10. Wang HH et al (2015) Hospital surgical volume and associated postoperative complications of pediatric urological surgery in the United States. J Urol 194(2):506–511

    Article  PubMed  PubMed Central  Google Scholar 

  11. Almatar A et al (2016) Effect of radical prostatectomy surgeon volume on complication rates from a large population-based cohort. Can Urol Assoc J 10(1–2):45–49

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mowat A, Maher C, Ballard E (2016) Surgical outcomes for low-volume vs high-volume surgeons in gynecology surgery: a systematic review and meta-analysis. Am J Obstet Gynecol 215(1):21–33

    Article  PubMed  Google Scholar 

  13. Vree FE et al (2014) The impact of surgeon volume on perioperative outcomes in hysterectomy. JSLS 18(2):174–181

    Article  PubMed  PubMed Central  Google Scholar 

  14. Weng SF et al (2014) Renal transplantation: relationship between hospital/surgeon volume and postoperative severe sepsis/graft-failure. A Nationwide Population-based study. Int J Med Sci 11(9):918–924

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lau RL et al (2012) The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 13:250

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ames JB et al (2010) Does surgeon volume for total hip arthroplasty affect outcomes after hemiarthroplasty for femoral neck fracture? Am J Orthop (Belle Mead NJ) 39(8):E84–E89

    Google Scholar 

  17. Katz JN et al (2003) Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum 48(2):560–568

    Article  PubMed  Google Scholar 

  18. Moher D et al (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341

    Article  Google Scholar 

  19. Atkins D et al (2004) Grading quality of evidence and strength of recommendations. BMJ 328(7454):1490

    Article  PubMed  Google Scholar 

  20. Farjoodi P, Skolasky RL, Riley LH (2011) The effects of hospital and surgeon volume on postoperative complications after lumbar spine surgery. Spine (Phila Pa 1976) 36(24):2069–2075

    Article  Google Scholar 

  21. Dasenbrock HH et al (2012) The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis. Neurosurgery 70(6):1346–1353 (discussion 1353–4)

    Article  PubMed  Google Scholar 

  22. Cole T et al (2017) Surgeon procedure volume and complication rates in anterior cervical discectomy and fusions: analysis of a national longitudinal database. Clin Spine Surg 30(5):E633–E639

    PubMed  Google Scholar 

  23. Basques BA et al (2017) Effect of surgeon volume on complications, length of stay, and costs following anterior cervical fusion. Spine (Phila Pa 1976) 42(6):394–399

    Article  Google Scholar 

  24. Paul JC, Lonner BS, Toombs CS (2015) Greater operative volume is associated with lower complication rates in adolescent spinal deformity surgery. Spine (Phila Pa 1976) 40(3):162–170

    Article  Google Scholar 

  25. De la Garza Ramos R et al (2017) Volume-outcome relationship after 1 and 2 level anterior cervical discectomy and fusion. World Neurosurg 105:543–548

    Article  PubMed  Google Scholar 

  26. Blais MB et al (2017) Establishing objective volume-outcome measures for anterior and posterior cervical spine fusion. Clin Neurol Neurosurg 161:65–69

    Article  PubMed  Google Scholar 

  27. Bederman SS et al (2009) The who, what and when of surgery for the degenerative lumbar spine: a population-based study of surgeon factors, surgical procedures, recent trends and reoperation rates. Can J Surg 52(4):283–290

    PubMed  PubMed Central  Google Scholar 

  28. Paul JC et al (2015) Complication rates are reduced for revision adult spine deformity surgery among high-volume hospitals and surgeons. Spine J 15(9):1963–1972

    Article  PubMed  Google Scholar 

  29. Schoenfeld AJ et al (2017) Examining healthcare segregation among racial and ethnic minorities receiving spine surgical procedures in the state of Florida. Spine 42(24):1917–1922

    Article  PubMed  Google Scholar 

  30. Shervin N, Rubash HE, Katz JN (2007) Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res 457:35–41

    Article  PubMed  Google Scholar 

  31. Agency for Healthcare Research Quality (AHRQ) Agency for Healthcare Research Quality (AHRQ) HCUP Databases, Healthcare Cost and Utilization Project (HCUP): overview of the Nationwide Inpatient Sample (NIS) (2013). http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 01 Sep 2017

  32. An introduction to statewide inpatient databases. https://www.hcup-us.ahrq.gov/db/state/siddist/SID_Introduction.jsp. Accessed 01 Sep 2017

  33. Birkmeyer JD et al (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349(22):2117–2127

    Article  CAS  PubMed  Google Scholar 

  34. Luft HS, Hunt SS, Maerki SC (1987) The volume-outcome relationship: practice-makes-perfect or selective-referral patterns? Health Serv Res 22(2):157–182

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Halm EA, Lee C, Chassin MR (2002) Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 137(6):511–520

    Article  PubMed  Google Scholar 

  36. Bozic KJ et al (2010) The influence of procedure volumes and standardization of care on quality and efficiency in total joint replacement surgery. J Bone Jt Surg Am 92(16):2643–2652

    Article  Google Scholar 

  37. Coffey RJ et al (1992) An introduction to critical paths. Qual Manag Health Care 1(1):45–54

    Article  CAS  PubMed  Google Scholar 

  38. Chung SB et al (2012) Implementation and outcomes of a critical pathway for lumbar laminectomy or microdiscectomy. J Korean Neurosurg Soc 51(6):338–342

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dimick J et al (2013) Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions. Health Aff (Millwood) 32(6):1046–1053

    Article  Google Scholar 

  40. Sclafani JA, Kim CW (2014) Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res 472(6):1711–1717

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nandyala SV et al (2014) Minimally invasive transforaminal lumbar interbody fusion: one surgeon’s learning curve. Spine J 14(8):1460–1465

    Article  PubMed  Google Scholar 

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Correspondence to Azeem Tariq Malik.

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Malik, A.T., Panni, U.Y., Mirza, M.U. et al. The impact of surgeon volume on patient outcome in spine surgery: a systematic review. Eur Spine J 27, 530–542 (2018). https://doi.org/10.1007/s00586-017-5447-2

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  • DOI: https://doi.org/10.1007/s00586-017-5447-2

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