Volume Benchmarks for Common Lumbar Spine Surgeries Defined in Recent Study

This study intends to start the conversation, commented lead author, Andrew J. Schoenfeld, MD, MSc.

Volume benchmarks for common lumbar spine surgeries were defined in a retrospective review published online ahead of print in The Spine Journal. Surgeons would need to perform an average of four discectomy and lumbar interbody fusion procedures per month, three posterolateral lumbar fusions per month, and at least one decompression surgery every other week to be defined as having “some degree of proficiency” in these surgeries, according to the findings.
Portrait of confident surgeon in operating room.Surgeon volume has been defined and used as a quality measure in a variety of surgical specialties. Photo Source: 123RF.com.Surgeons who performed fewer than these benchmark volumes were at significantly increased risk of complications and hospital readmission, the researchers reported.

Importance of Surgeon Volume as a Quality Measure

Surgeon volume has been defined and used as a quality measure in a variety of surgical specialties, explained lead author Andrew J. Schoenfeld, MD, MSc, Assistant Professor in the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

“Increasingly, hospitals and some insurance carriers are using these measures to ensure surgeons are facile with the procedures they perform,” Dr. Schoenfeld told SpineUniverse. “Previous research into the volume-outcome relationship has indicated that the spine surgical field is one in which such a relationship would be likely to exist. In order to help practitioners accurately benchmark their procedural performance, the establishing of objective volume-outcome metrics is necessary.”

Dr. Schoenfeld and colleagues used data from the Florida Inpatient Dataset for the years 2011-2014 to develop procedural benchmarks associated with reductions in complications or hospital readmissions within 90-days of surgery for the following four common lumbar spine surgeries: discectomy, decompression, lumbar interbody fusion, and lumbar posterolateral fusion.

A total of 187,185 spine surgeries performed by 5,514 different surgeons at 178 hospitals in Florida met the study inclusion criteria. Within 90 days of the procedure, 3,829 patients died (2%), 30,046 were readmitted to the hospital (16%), and 17,588 had one or more complications (9.4%).

As shown in the Table, the procedure volume benchmarks ranged from 25 to 43. Surgeons who failed to meet these benchmarks were at significantly increased risk for complications and hospital readmission (by 15% to 63% and 11% to 45%, respectively, depending on procedure).
Table. Influence of Surgeon Volume on Relative Risk of Complications and 90-day Hospital Readmission

Clinical Implications of Volume-Based Benchmarks

The researchers suggested that these benchmarks could be used immediately by individual surgeons to determine if their annual performance meets these goals. They noted that external validation is needed before these benchmarks can be applied on a widespread basis. In the future, hospitals may require attainment of certain procedural performance measures, and third-party payers may restrict preferred provider networks or incentivize payments to surgeons who meet the benchmarks each year, the researchers added.

“This study is intended to start the conversation and not be seen as a definitive work with clearly articulated recommendations for benchmarking,” Dr. Schoenfeld said.

Disclosure: Dr. Schoenfeld disclosed no relevant financial relationships.

Updated on: 09/17/19
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