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Variations in Surgical Practice and Short-term Outcomes for Degenerative Lumbar Scoliosis and Spondylolisthesis: Do Surgeon Training and Experience Matter? – Lumbar Fusion

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The article examines surgeon-level variations in spinal surgery practice and short-term outcomes for degenerative lumbar spine conditions. The study analyzed data from two large spine surgery centers in one region from 2017 to 2019. The results showed significant variation among surgeons in terms of operative volume, the use of instrumented fusion (a procedure with device-related risks), and postoperative outcomes. Orthopaedic surgeons and fellowship-trained surgeons were more likely to perform instrumented fusion for scoliosis. Surgeons with higher operative volumes had a higher likelihood of using instrumented fusion and had lower rates of major in-hospital complications. These findings suggest that surgical specialty, subspecialty, and recent operative volume can influence practice patterns and outcomes in spinal surgery. The study highlights the potential for optimizing surgical practice through residency and fellowship training. PMID: 38156345 | DOI: 10.1093/intqhc/mzad109

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

: Surgical practice can vary greatly for degenerative spine conditions, even within the same region and among colleagues at the same institution. Surgical specialty and subspecialty, in addition to recent operative volume, can be linked to variations in spine surgeons’ practice patterns and outcomes. These findings reinforce the notion that residency and fellowship training may contribute to variation and present important opportunities to optimize surgical practice over the course of…

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Int J Qual Health Care. 2023 Dec 29:mzad109. doi: 10.1093/intqhc/mzad109. Online ahead of print.ABSTRACTBACKGROUND: For diverse procedures, sizeable geographic variation exists in rates and outcomes of surgery, including for degenerative lumbar spine conditions. Little is known about how surgeon training and experience are associated with surgeon-level variations in spine surgery practice and short-term outcomes.METHODS: This,

Int J Qual Health Care. 2023 Dec 29:mzad109. doi: 10.1093/intqhc/mzad109. Online ahead of print.

ABSTRACT

BACKGROUND: For diverse procedures, sizeable geographic variation exists in rates and outcomes of surgery, including for degenerative lumbar spine conditions. Little is known about how surgeon training and experience are associated with surgeon-level variations in spine surgery practice and short-term outcomes.

METHODS: This retrospective observational analysis characterized variations in surgical operations for degenerative lumbar scoliosis or spondylolisthesis, two common age-related conditions. The study setting was two large spine surgery centers in one region during 2017-2019. Using data (ICD-10-CM, CPT codes) extracted from electronic health record systems, we characterized surgeon-level variations in practice (use of instrumented fusion, a more extensive procedure that involves device-related risks) and short-term postoperative outcomes (major in-hospital complications, readmissions). Next, we tested for associations between surgeon training (specialty, spine fellowship) and experience (career stage, operative volume) and use of instrumented fusion as well as outcomes.

RESULTS: Eighty-nine surgeons performed 2,481 eligible operations. For the study diagnoses, spine surgeons exhibited substantial variation in operative volume, use of instrumented fusion, and postoperative outcomes. Among surgeons above the median operative volume, use of instrumented fusion ranged from 0% to >90% for scoliosis and 9% to 100% for spondylolisthesis, while rates of major in-hospital complications ranged from 0% to 25% for scoliosis and from 0% to 14% for spondylolisthesis. For scoliosis, orthopaedic surgeons were more likely than neurosurgeons to perform instrumented fusion for scoliosis (49% vs. 33%, odds ratio [OR]=2.3, 95% confidence interval [95% CI] 1.3-4.2, p-value=0.006), as were fellowship trained surgeons (49% vs. 25%, OR=3.0, 95% CI 1.6-5.8; p=0.001)). Fellowship-trained surgeons had lower readmission rates. Surgeons with higher operative volumes used instrumented fusion more often (OR 1.1, 95% CI 1.0-1.2, p<0.05 for both diagnoses) and had lower rates of major in-hospital complications (OR=0.91, 95% CI 0.85- 0.97; p=0.006).

: Surgical practice can vary greatly for degenerative spine conditions, even within the same region and among colleagues at the same institution. Surgical specialty and subspecialty, in addition to recent operative volume, can be linked to variations in spine surgeons’ practice patterns and outcomes. These findings reinforce the notion that residency and fellowship training may contribute to variation and present important opportunities to optimize surgical practice over the course of surgeons’ careers. Future efforts to reduce unexplained variation in surgical practice could test interventions focused on graduate medical education.

PMID:38156345 | DOI:10.1093/intqhc/mzad109

The London Spine Unit : most experienced spinal centre in the world

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Variations in Surgical Practice and Short-term Outcomes for Degenerative Lumbar Scoliosis and Spondylolisthesis: Do Surgeon Training and Experience Matter?

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Int J Qual Health Care. 2023 Dec 29:mzad109. doi: 10.1093/intqhc/mzad109. Online ahead of print.ABSTRACTBACKGROUND: For diverse procedures, sizeable geographic variation exists in rates and outcomes of surgery, including for degenerative lumbar spine conditions. Little is known about how surgeon training and experience are associated with surgeon-level variations in spine surgery practice and short-term outcomes.METHODS: This

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