Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis

Li, Huizi; Zhong, Lin; Li, Zongze; Yang, Zeng-Yan; Zheng, Yang; Li, Yong; Lu, Huading

doi:10.21037/atm.2018.10.48

Cited by 13 publications

(10 citation statements)

References 53 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is an important point as previous literature has often demonstrated lower perioperative morbidity,3–5 but has failed to examine long term outcomes and PRO as a result of surgeon experience in lumbar fusion. Similarly, higher surgeon volume has been historically associated with lower morbidity18–20 and demonstrated statically significant positive correlation with likelihood of achieving MCID after lumbar fusion in this study. In addition to these traditional surgeon factors, concordance with evidence-based indications for lumbar fusion (NASS criteria) were examined for effects on patient outcomes when comparing surgeons.…”

Section: Discussionsupporting

confidence: 63%

“…Another traditional variable correlating with many surgical outcomes is surgeon volume. [9][10][11][12] Although many fields have associated surgeon volume with improved outcomes; scoliosis surgery, 13,14 anterior cervical discectomy and fusion, [15][16][17] and lumbar fusions [18][19][20] have also seen fewer complications and lower length of stay associated with higher surgeon volume. Recent studies have even attempted to establish benchmarks for surgeon volume to decrease odds of perioperative complications.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

Hines¹,

Philipp²,

Thalheimer³

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

Study Design: The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population. Objective: This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics. Summary of Background Data: Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited. Methods: This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI. Results: A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression (P=0.0340 and P=0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID. Conclusion: This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.

show abstract

Section: Discussionsupporting

confidence: 63%

mentioning

confidence: 99%

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

Hines¹,

Philipp²,

Thalheimer³

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

show abstract

“…However, it is worth mentioning that these features are comparable to those of prior similar reports in the spinal fusion literature. 5,6,18,34,35 Several reports have shown that surgeon experience (as indicated by number of years in practice) 36 and case volume 37 correlate with the accuracy rate of freehand pedicle screw placement and postoperative outcomes. Therefore, Copyright r 2022 Wolters Kluwer Health, Inc. All rights reserved.…”

Section: Limitationsmentioning

confidence: 99%

Safety and Accuracy of Freehand Pedicle Screw Placement and the Role of Intraoperative O-arm: A Single Institution Experience

Alomari

Lubelski

Lehner

et al. 2022

Spine

View full text Add to dashboard Cite

The aim was to investigate the accuracy of pedicle screw placement by freehand technique and to compare revision surgery rates among three different imaging verification pathways. Summary of Background Data: Studies comparing different imaging modalities in freehand screw placement surgery are limited. Materials and Methods: A single-institution retrospective chart review identified adult patients who underwent freehand pedicle screw placement in the thoracic, lumbar or sacral levels. Patients were stratified into three cohorts based on the intraoperative imaging modality used to assess the accuracy of screw position: intraoperative X-rays (cohort 1); intraoperative O-arm (cohort 2); or intraoperative computed tomography (CT)-scan (cohort 3). Postoperative CT scans were performed on all patients in cohorts 1 and 2. Postoperative CT scan was not required in cohort 3. Screw accuracy was assessed using the Gertzbein-Robbins grading system. Results: A total of 9179 pedicle screws were placed in the thoracic or lumbosacral spine in 1311 patients. 210 (2.3%) screws were identified as Gertzbein-Robbins grades C-E on intraoperative/postoperative CT scan, 137 thoracic screws, and 73 lumbar screws (P < 0.001). Four hundred and nine patients underwent placement of 2754 screws followed by intraoperative X-ray (cohort 1); 793 patients underwent placement of 5587 screws followed by intraoperative O-arm (cohort 2); and 109 patients underwent placement of 838 screws followed by intraoperative CT scan (cohort 3). Postoperative CT scans identified 65 (2.4%) and 127 (2.3%) malpositioned screws in cohorts 1 and 2, respectively. Eleven screws (0.12%) were significantly malpositioned and required a second operation for screw revision. Nine patients (0.69%) required revision operations: eight of these patients were from cohort 1 and one patient was from cohort 2. Conclusion: When compared to intraoperative X-ray, intraoperative O-arm verification decreased the revision surgery rate for malpositioned screws from 0.37% to 0.02%. In addition, our analysis suggests that the use of intraoperative O-arm can obviate the need for postoperative CT scans.

show abstract

“…Previous reports in the literature demonstrate a relationship between greater surgical volume and decreased complication rates for both ACDF and spinal procedures overall. 31,32 In a survey study of orthopaedic surgical resident perspectives on case minimums and preparation for post-residency practice, spinal cases were among the most frequently cited as needing more experience with as the volume of cases were less than other orthopaedic surgical procedures. 33 The present study demonstrated significant reductions in both admission to operation time and operation time of ACDF performed for myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following outpatient anterior cervical discectomy and fusion for the treatment of myelopathy

Lee

Iweala

et al. 2021

Journal of Clinical Orthopaedics and Trauma

View full text Add to dashboard Cite

Introduction: Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of degenerative cervical disease. With continued increase in U.S. healthcare expenditure, surgeons have begun to more closely examine the benefits of performing ACDF in an outpatient setting to increase efficiency, reduce the overall financial burden on patients/providers, and provide streamlined care for these patients. The purpose of this study was to analyze outcomes following outpatient ACDF for the treatment of myelopathy. Methods: 14,490 patients who had undergone ACDF for myelopathy from 2010 to 2018 were included in this retrospective study, of which 2956 (20.40%) patients were considered to have undergone outpatient surgery. Pearson chi-squared tests and Fischer's Exact Tests were used to analyze differences in categorical variables of demographics, preoperative comorbidities, and postoperative complications, while Mann-Whitney-U-Tests were used to compare mean values of continuous variables. Coarsened-exactmatching (CEM) was implemented to control for baseline differences in demographics and comorbidities, and post-matching diagnostics included multivariate and univariate imbalance measure assessment. Outcomes were compared between the CEM-matched inpatient and outpatients ACDF cohorts. Results: Upon CEM-matching (L1-statistic <0.001), the outpatient cohort (n ¼ 2610, 25.13%) demonstrated significantly lower rates of any complication (p < 0.001), minor complications (p ¼ 0.001), urinary tract infections (p ¼ 0.029), blood transfusions (p < 0.001), major complications (p < 0.001), deep incisional surgical site infections (p ¼ 0.017), ventilator dependence (p ¼ 0.027), cardiac arrest (p ¼ 0.028), unplanned reoperations (p ¼ 0.001), and mortality (p ¼ 0.006) in the 30-day postoperative period when compared to inpatient controls (n ¼ 7774, 74.87%). Conclusion: ACDF has been a target amongst spinal procedures as a prime candidate for outpatient surgery. However, no previous reports have described complication rates and perioperative parameters in the sub-population of outpatient ACDF patients with myelopathy. In addition to shorter times from admission to operating room, operative time, and LOS, our study also demonstrated lower rates of major and overall complications in outpatient ACDF's for myelopathy in comparison to their inpatient counterparts. Performing ACDF's for myelopathy in an outpatient setting may help to curb costs, improve outcomes, and serve as a valuable learning resource for graduate medical education with rapid turnovers and shorter operative times.

show abstract

Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis

Cited by 13 publications

References 53 publications

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

Increased Surgeon-specific Experience and Volume is Correlated With Improved Clinical Outcomes in Lumbar Fusion Patients

Safety and Accuracy of Freehand Pedicle Screw Placement and the Role of Intraoperative O-arm: A Single Institution Experience

Outcomes following outpatient anterior cervical discectomy and fusion for the treatment of myelopathy

Contact Info

Product

Resources

About