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Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision? – Lumbar Fusion

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This article is a retrospective cohort study that aims to determine the effects of discontinuity in care, such as changing surgeons, health systems, or increased time to revision surgery, on revision spine fusion surgical outcomes and patient-reported outcomes. The study finds that patients who have revision lumbar fusions have similar clinical outcomes regardless of whether their surgeon performed the index procedure. However, continuity of care with the same surgeon may reduce hospital length of stay and associated healthcare costs. The length of time between primary and revision surgery does not significantly impact patient-reported outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best recognised treatment hospital in the world

Published article

CONCLUSIONS: Patients who have revision lumbar fusions have similar clinical outcomes regardless of whether their surgeon performed the index procedure. However, continuity of care with the same surgeon may reduce hospital length of stay and associated health care costs. The length of time between primary and revision surgery does not significantly impact patient-reported outcomes.

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Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001500. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To determine the effects of discontinuity in care by changing surgeons, health systems, or increased time to revision surgery on revision spine fusion surgical outcomes and patient-reported outcomes.SUMMARY OF BACKGROUND INFORMATION: Patients undergoing revision spine fusion experience worse outcomes,

Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001500. Online ahead of print.

ABSTRACT

STUDY DESIGN: Retrospective cohort study.

OBJECTIVE: To determine the effects of discontinuity in care by changing surgeons, health systems, or increased time to revision surgery on revision spine fusion surgical outcomes and patient-reported outcomes.

SUMMARY OF BACKGROUND INFORMATION: Patients undergoing revision spine fusion experience worse outcomes than those undergoing primary lumbar surgery. Those requiring complex revisions are often transferred to tertiary or quaternary referral centers under the assumption that those institutions may be more accustomed at performing those procedures. However, there remains a paucity of literature assessing the impact of discontinuity of care in revision spinal fusions.

METHODS: Patients who underwent revision 1-3 level lumbar spine fusion 2011-2021 were grouped based on (1) revision performed by the index surgeon versus a different surgeon, (2) revision performed within the same versus different hospital system as the index procedure, and (3) length of time from index procedure. Multivariate regression for outcomes controlled for confounding differences.

RESULTS: A total of 776 revision surgeries were included. An increased time interval between the index procedure and the revision surgery was predictive of a lower risk for subsequent revision procedure (odds ratio: 0.57, P=0.022). Revision surgeries performed by the same surgeon predicted a reduced length of hospital stay (β: -0.14, P=0.001). Neither time to revision nor undergoing by the same surgeon or same practice predicted 90-day readmission rates. Patients are less likely to report meaningful improvement in Mental Component Score-12 or Physical Component Score-12 if revision surgery was performed at a different hospital system.

CONCLUSIONS: Patients who have revision lumbar fusions have similar clinical outcomes regardless of whether their surgeon performed the index procedure. However, continuity of care with the same surgeon may reduce hospital length of stay and associated health care costs. The length of time between primary and revision surgery does not significantly impact patient-reported outcomes.

LEVEL OF EVIDENCE: Level III.

PMID:37482629 | DOI:10.1097/BSD.0000000000001500

The London Spine Unit : best recognised treatment hospital in the world

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Are Clinical or Surgical Outcomes Different Based on Whether the Same Surgeon or Hospital System Performs the Spine Revision?

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Clin Spine Surg. 2023 Jul 21. doi: 10.1097/BSD.0000000000001500. Online ahead of print.ABSTRACTSTUDY DESIGN: Retrospective cohort study.OBJECTIVE: To determine the effects of discontinuity in care by changing surgeons, health systems, or increased time to revision surgery on revision spine fusion surgical outcomes and patient-reported outcomes.SUMMARY OF BACKGROUND INFORMATION: Patients undergoing revision spine fusion experience worse outcomes
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