(Press-News.org) Philadelphia, Pa. (June 7, 2012) - For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
In contrast, the complication rate is not significantly affected by the volume of spinal stenosis surgeries performed at the hospital, according to the new research. The senior author was Dr. Ali Bydon of Johns Hopkins Unviersity.
'Very Low' Volume Surgeons Have Higher Complication Rates
Using a large database of hospitalized patients, the researchers analyzed outcomes in nearly 49,000 patients undergoing surgery for lumbar spinal stenosis—narrowing of the spinal canal in the lower back. Rates of complications and in-hospital death were compared for surgeons and hospitals with different "volumes" of surgery for spinal stenosis from 2005 through 2008.
The volume of spinal stenosis surgeries by each surgeon was categorized from "very low" (less than 15 operations over four years) to "very high" (more than 81 procedures in four years). Hospital volume ranged from less than 68 to more than 394. These categories were compared with the risk of complications and death, with adjustment for other factors.
Complication rate ranged from 11.6 percent for patients operated on by surgeons with a very low volume of spinal stenosis surgeries to 8.6 percent for surgeons who performed a very high volume of procedures. On adjusted analysis, the risk was 38 percent higher for surgeons in the very low volume category, compared to the very high volume category. Risk was not significantly increased for surgeons at intermediate levels (low, medium, or high).
After adjustment for surgeon volume, the volume of surgeries performed at the hospital did not significantly affect complication rate. Hospital volume was also unrelated to the total cost of the procedure or the number of days spent in the hospital. Neither surgeon volume nor hospital volume significantly affected the risk of death.
For several types of relatively "high-risk" surgical procedures—coronary artery bypass graft surgery, for example—outcomes tend to be better when the procedure is performed by surgeons and at hospitals that perform more such procedures. Few studies have looked at how surgeon and hospital volume affect the outcomes of spine surgery. Spinal stenosis is a common cause of back pain, especially in older people. Surgery is recommended for patients who don't improve with other treatments.
The new study suggests that surgeon volume affects the risk of complications from lumbar spinal stenosis surgery. However, the difference is significant only on comparison of the lowest- versus highest-volume surgeons: averaging less than four versus more than 20 procedures per year.
Dr. Bydon and coauthors write, "[F]or patients undergoing surgery for lumbar spinal stenosis, the individual surgeon's experience, skill, and clinical knowledge may be key determinants of outcomes, whereas hospital resources may be of secondary importance." They note that most of the high- and very high-volume surgeons in their study practiced at larger, university-affiliated hospitals.
However, they also point out that more than 40 percent of these higher-volume surgeons didn't work at large university hospitals—in fact, many worked at smaller or rural hospitals. "Therefore," the researchers add, "the resources of a large academic medical center or a large, urban hospital may not be necessary for a high-volume spine surgeon."
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About Neurosurgery
Neurosurgery, the Official Journal of the Congress of Neurological Surgeons, is your most complete window to the contemporary field of neurosurgery. Members of the Congress and non-member subscribers receive 3,000 pages per year packed with the very latest science, technology, and medicine, not to mention full-text online access to the world's most complete, up-to-the-minute neurosurgery resource. For professionals aware of the rapid pace of developments in the field, Neurosurgery is nothing short of indispensable.
About Lippincott Williams & Wilkins
Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).
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