Repeat surgery after lumbar decompression for herniated disc: the quality implications of hospital and surgeon variation.

Abstract

BACKGROUND CONTEXT:

Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates.

PURPOSE:

To examine hospital- and surgeon-level variation in reoperation rates after lumbar herniated disc surgery and to relate these to published benchmarks.

STUDY DESIGN/SETTING:

Retrospective analysis of a discharge registry including all nonfederal hospitals in Washington State.

METHODS:

We identified adults who underwent an initial inpatient lumbar decompression for herniated disc from 1997 to 2007. We then performed generalized linear mixed-effect logistic regressions, controlling for patient characteristics and comorbidity, to examine the variation in reoperation rates within 90 days, 1 year, and 4 years.

RESULTS:

Our cohort included 29,529 patients with a mean age of 47.5 years, 61% privately insured, and 15% having any comorbidity. The age-, sex-, insurance-, and comorbidity-adjusted mean rate of reoperation among hospitals was 1.9% at 90 days (95% confidence interval [CI], 1.2-3.1), with a range from 1.1% to 3.4%; 6.4% at 1 year (95% CI, 3.9-10.6), with a range from 2.8% to 12.5%; and 13.8% at 4 years (95% CI, 8.8-19.8), with a range from 8.1% to 24.5%. The adjusted mean reoperation rates of surgeons were 1.9% at 90 days (95% CI, 1.4-2.4) with a range from 1.2% to 4.6%, 6.1% at 1 year (95% CI, 4.8-7.7) with a range from 4.3% to 10.5%, and 13.2% at 4 years (95% CI, 11.3-15.5) with a range from 10.0% to 19.3%. Multilevel random-effect models suggested that variation across surgeons was greater than that of hospitals and that this effect increased with long-term outcomes.

CONCLUSIONS:

Even after adjusting for patient demographics and comorbidity, we observed a large variation in reoperation rates across hospitals and surgeons after lumbar discectomy, a relatively simple spinal procedure. These findings suggest uncertainty about indications for repeat surgery, variations in perioperative care, or variations in quality of care.

• Authors: Brook I Martin, Sohail K Mirza, David R Flum, Thomas M Wickizer, Patrick J Heagerty, Alex F Lenkoski, Richard A Deyo
• Journal: The spine journal : official journal of the North American Spine Society (Spine J) Vol. 12 Issue 2 Pg. 89-97 (Feb 2012) ISSN: 1878-1632 [Electronic] United States
• PMID: 22193055 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Topics

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Decompression, Surgical (statistics & numerical data)
• Diskectomy (statistics & numerical data)
• Female
• Humans
• Intervertebral Disc Displacement (surgery)
• Low Back Pain (surgery)
• Lumbar Vertebrae (surgery)
• Male
• Middle Aged
• Registries
• Reoperation
• Retrospective Studies
• Sex Factors
• Spinal Fusion (statistics & numerical data)