Dataset Information

The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA.

ABSTRACT:

Purpose

There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the USA. The purpose of this study was to investigate the association of spinal fusion operations with several socioeconomic factors.

Methods

We performed a retrospective cohort study involving patients who underwent any neurosurgical procedure from 2005 to 2010 and were registered in National Inpatient Sample (NIS). A sub-cohort of patients undergoing spinal operations was also created. Regression techniques were used to investigate the association of the average intensity of neurosurgical care (defined as the average number of neurosurgical procedures per capita) with the average rate of fusions.

Results

In the study period, there were 707,951 patients undergoing spinal procedures, who were registered in NIS. There were significant disparities in the fusion rate among different states (ANOVA, P < 0.0001), which ranged from 0.41 in Maine, where non-fusion surgeries were very predominant, to 0.62 in Virginia, where fusion was the main treatment modality used. In a multivariate analysis, the intensity of neurosurgical care was associated with an increased fusion rate. A similar effect was observed for coverage by private insurance, higher income, urban hospitals, large hospital size, African American patients, and patients with less comorbidities. Hospital location in the northeast was associated with a lower rate in comparison to the midwest, and south. Coverage by Medicaid was associated with lower fusion rate.

Conclusions

We observed significant disparities in the integration of fusion operations in spine surgery practices in the USA. Increased intensity of neurosurgical care was associated with a higher fusion rate.

SUBMITTER: Bekelis K

PROVIDER: S-EPMC3960423 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Publications

The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA.

Bekelis Kimon K Missios Symeon S

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 20140204 4

<h4>Purpose</h4>There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the USA. The purpose of this study was to investigate the association of spinal fusion operations with several socioeconomic factors.<h4>Methods</h4>We performed a retrospective cohort study involving patients who underwent any neurosurgical procedure from 2005 to 2010 and were registered in National Inpatient Sample (NIS). A sub-cohort of patients undergoing spinal o ...[more]

PMID: 24492948

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Project description:Importance: Use of health care services and physician practice patterns have been shown to vary widely across the United States. Although practice patterns-in particular, physicians' ability to provide high-quality, high-value care-develop during training, the association of a physician's regional practice environment with that ability is less well understood.Objective: To examine the association between health care intensity in the region where physicians practice and their ability to practice high-value care, specifically for physicians whose practice environment changed due to relocation after residency.Design, setting, and participants: This cohort study included a national sample of 3896 internal medicine physicians who took the 2002 American Board of Internal Medicine initial certification examination followed approximately 1 decade (April 21, 2011, to May 7, 2015) later by the Maintenance of Certification (MOC) examination. At the time of the MOC examination, 2714 of these internists were practicing in a new region. Data were analyzed from March 6, 2016, to May 21, 2018.Exposures: Intensity of care in the Dartmouth Atlas hospital referral region (HRR), measured by per-enrollee end-of-life physician visits (primary) and current practice type (secondary).Main outcomes and measures: The outcome, a physician's ability to practice high-value care, was assessed using the Appropriately Conservative Management (ACM) score on the MOC examination, measuring performance across all questions for which the correct answer was the most conservative option. The exposure, regional health care intensity, was measured as per-enrollee end-of-life physician visits in the Dartmouth Atlas HRR of the physician's practice.Results: Among the 3860 participating internists included in the analysis (2030 men [52.6%]; mean [SD] age, 45.6 [4.5] years), those who moved to regions in the quintile of highest health care intensity had an ACM score 0.22 SD lower (95% CI, -0.32 to -0.12) than internists who moved to regions in the quintile of lowest intensity, controlling for postresidency ACM scores. This difference reflected scoring in the 44th compared with the 53rd percentile of all examinees. This association was mildly attenuated (0.18 SD less; 95% CI, -0.28 to -0.09) after adjustment for physician and practice characteristics.Conclusions and relevance: This study found that practice patterns of internists who relocate after residency training appear to migrate toward norms of the new region. The demands of practicing in high-intensity regions may erode the ability to practice high-value conservative care.

Project description:Importance:Overlapping surgery (OS) is common. However, there is a dearth of evidence to support or refute the safety of this practice. Objective:To determine whether OS is associated with worsened morbidity and mortality in a large series of neurosurgical cases. Design, Setting, and Participants:A retrospective cohort study was completed for patients who underwent neurosurgical procedures at Emory University Hospital, a large academic referral hospital, between January 1, 2014, and December 31, 2015. Patients were operated on for pathologies across the spectrum of neurosurgical disorders. Propensity score weighting and logistic regression models were executed to compare outcomes for patients who received nonoverlapping surgery and OS. Investigators were blinded to study cohorts during data collection and analysis. Main Outcomes and Measures:The primary outcome measures were 90-day postoperative mortality, morbidity, and functional status. Results:In this cohort of 2275 patients who underwent neurosurgery, 1259 (55.3%) were female, and the mean (SD) age was 52.1 (16.4) years. A total of 972 surgeries (42.7%) were nonoverlapping while 1303 (57.3%) were overlapping. The distribution of American Society of Anesthesiologists score was similar between nonoverlapping surgery and OS cohorts. Median surgical times were significantly longer for patients in the OS cohort vs the nonoverlapping surgery cohort (in-room time, 219 vs 188 minutes; skin-to-skin time, 141 vs 113 minutes; both P < .001). Overlapping surgery was more frequently elective (93% vs 87%; P < .001). Regression analysis failed to demonstrate an association between OS and complications, such as mortality, morbidity, or worsened functional status. Measures of baseline severity of illness, such as admission to the intensive care unit and increased length of stay, were associated with mortality (intensive care unit: odds ratio [OR], 25.5; 95% CI, 6.22-104.67; length of stay: OR, 1.03; 95% CI, 1.00-1.05), morbidity (intensive care unit: OR, 1.85; 95% CI, 1.43-2.40; length of stay: OR, 1.06; 95% CI, 1.04-1.08), and unfavorable functional status (length of stay: OR, 1.03; 95% CI, 1.02-1.05). Conclusions and Relevance:These data suggest that OS can be safely performed if appropriate precautions and patient selection are followed. Data such as these will help determine health care policy to maximize patient safety.

Dataset Information

The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA.

Purpose

Methods

Results

Conclusions

Publications

The association of regional intensity of neurosurgical care with spinal fusion surgery in the USA.

Similar Datasets

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