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Practice Variation Among Surgeons Treating Lumbar Spinal Stenosis in a Single Institution

STUDY DESIGN: Retrospective study OBJECTIVE.: To examine practice variation in the treatment of lumbar spinal stenosis and identify targets for reducing variation. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis is a degenerative condition susceptible to practice variation. Reducing variation aims to improve quality, increase safety, and lower costs. Establishing differences in surgeons’ practices from a single institution can help identify personalized variation. METHODS: We identified adult patients first diagnosed with lumbar spinal stenosis between 2003 and 2015 in three hospitals of the same institution with ICD-9 codes.We extracted number of office visits, imaging procedures, injections, EMG’s, and surgery within the first year after diagnosis; physical therapy within the first 3 months after diagnosis. Multivariable logistic regression was used to identify factors associated with surgery. The coefficient of variation (CV) was calculated to compare the variation in practice. RESULTS: The 10,858 patients we included had an average of 2.5 visits (+/-1.9), 1.5imaging procedures (+/-2.0), 0.03EMG’s (+/-0.22), and 0.16injections (+/-0.53); 36% had at least 1 surgical procedure and 32% had physical therapy as part of their care. The CV was smallest for number of visits (19%) and largest for EMG (140%).Male sex (Odds Ratio [OR]: 1.23, p

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