TY - JOUR
T1 - Geographic variation in lumbar fusion for degenerative disorders
T2 - 1990 to 2000
AU - Cook, Chad
AU - Santos, Guilherme Cunha M.
AU - Lima, Raquel
AU - Pietrobon, Ricardo
AU - Jacobs, Danny O.
AU - Richardson, William
N1 - Funding Information:
The Nationwide Inpatient Sample (NIS) database is part of the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality. The NIS is a cross-sectional database that includes approximately 20% of all nonfederal hospital discharges in the United States and is stratified by geographic region, urban or rural location; teaching status; ownership; and hospital size [25] . The NIS provides a representative sampling a number of states and hospitals whose hospital discharges were variably represented over the study period. Within the NIS, each hospitalization is recorded as an independent event. The database records patient demographic information, patient medical diagnoses by diagnosis-related group, procedure information by the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code's primary and secondary diagnoses; LOS; financial information; and admission and discharge information. The NIS database may be purchased through the Healthcare Cost and Utilization Project, a division of the Federal-State-Industry partnership (sponsored by the Agency for Healthcare Research and Quality), available at http://www.hcup-us.ahrq.gov/home.jsp . We used this database to observe changes in lumbar spine surgery between 1990 and 2000.
PY - 2007/9
Y1 - 2007/9
N2 - Background context: Past studies have shown that proportion of lumbar fusion surgery to all forms of lumbar surgery is variable among geographic regions. At present, no studies have investigated whether fusion outcome is associated with geographic region. Purpose: The purpose of this study was to examine the postoperative complication rate, postoperative mortality rate, hospital length of stay (LOS), hospital routine discharge rate, and total charges associated with surgical care across the geographic regions. Study design/setting: Retrospective cohort study using national sample administrative data. Patient sample: The study included 23,143 patients who underwent lumbar spine fusion surgery with a principal diagnosis of lumbar spine disease related to degeneration. Outcome measures: Functional measures included complication rate, mortality rate, and hospital LOS; routine discharge; and total charges for care. Methods: Selected variables from the Nationwide Inpatient Sample database were used for comparison across the geographic regions of the South, Midwest, Northeast, and West. Bivariate statistical analyses compared postoperative complication rates, mortality rates, hospital LOS, routine discharge rate, and total charges associated with surgical care across the geographic regions. Results: Significant differences in routine discharge (p<.001), cauda equina complications (p=.001), LOS (p<.001), and inflation-adjusted charges (p<.001) were found for the South and the West (demonstrated lower routine discharges and higher rates of complications involving cauda equina syndromes) and the Northeast and the Midwest (involved higher LOS than the South and the West but lower reported charges after adjustments for inflation). Conclusions: The findings suggest that surgical fusion outcome is associated with regional variations. It is likely that patient selection and physician preferences are associated with these findings. Similar to variations in proportion of lumbar fusion surgery among geographic regions, outcomes for surgical fusions also vary across regions.
AB - Background context: Past studies have shown that proportion of lumbar fusion surgery to all forms of lumbar surgery is variable among geographic regions. At present, no studies have investigated whether fusion outcome is associated with geographic region. Purpose: The purpose of this study was to examine the postoperative complication rate, postoperative mortality rate, hospital length of stay (LOS), hospital routine discharge rate, and total charges associated with surgical care across the geographic regions. Study design/setting: Retrospective cohort study using national sample administrative data. Patient sample: The study included 23,143 patients who underwent lumbar spine fusion surgery with a principal diagnosis of lumbar spine disease related to degeneration. Outcome measures: Functional measures included complication rate, mortality rate, and hospital LOS; routine discharge; and total charges for care. Methods: Selected variables from the Nationwide Inpatient Sample database were used for comparison across the geographic regions of the South, Midwest, Northeast, and West. Bivariate statistical analyses compared postoperative complication rates, mortality rates, hospital LOS, routine discharge rate, and total charges associated with surgical care across the geographic regions. Results: Significant differences in routine discharge (p<.001), cauda equina complications (p=.001), LOS (p<.001), and inflation-adjusted charges (p<.001) were found for the South and the West (demonstrated lower routine discharges and higher rates of complications involving cauda equina syndromes) and the Northeast and the Midwest (involved higher LOS than the South and the West but lower reported charges after adjustments for inflation). Conclusions: The findings suggest that surgical fusion outcome is associated with regional variations. It is likely that patient selection and physician preferences are associated with these findings. Similar to variations in proportion of lumbar fusion surgery among geographic regions, outcomes for surgical fusions also vary across regions.
KW - Charges for care
KW - Complications
KW - Geographic region
KW - Length of stay
KW - Lumbar
KW - Surgical fusion
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U2 - 10.1016/j.spinee.2006.09.010
DO - 10.1016/j.spinee.2006.09.010
M3 - Article
C2 - 17905317
AN - SCOPUS:34748912914
SN - 1529-9430
VL - 7
SP - 552
EP - 557
JO - Spine Journal
JF - Spine Journal
IS - 5
ER -