Objective
To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery.
Data sources
Discharge registry including all non-federal hospitals in Washington State from 2004–2007.
Study Design
We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether or not each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random-effects were used to examine complications, controlling for patient characteristics and comorbidity.
Principal findings
Complications within 90 days of a fusion occurred in 4.8% of patients, and 2.2% had a reoperation. Hospital effects accounted for 8.8% of the total variability, and surgeon effects account for 14.4%. Surgeon-factors account for 54.5% of the variation in hospital reoperation rates, and 47.2% of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of Bone Morphogenetic Proteins, accounted for 30% and 50% of the variation in surgeons’ reoperation and complication rates, respectively.
Conclusions
To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons’ discretionary use of operative techniques, may be more effective than those that target hospitals.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.