Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000

Cook, Chad; Santos, Guilherme Cunha M.; Lima, Raquel; Pietrobon, Ricardo; Jacobs, Danny O.; Richardson, William

doi:10.1016/j.spinee.2006.09.010

« Previous Next »The Spine Journal
Volume 7, Issue 5 , Pages 552-557, September 2007

Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000

Chad Cook, PT, PhD, MBA
- Division of Physical Therapy, DUMC 3907, Suite 050, Duke University, 042 Duke South Clinic Base, Durham, NC 27710, USA
- Corresponding author. Duke University, Division of Physical Therapy, 042 Duke South Clinic Base, Durham, NC 27710. Tel.: (919) 943-9179; fax: 919-668-3024.
Guilherme Cunha M. Santos, BS
- Minas Gerais Federal University, Av. Antônio Carlos, 6627 - Pampulha - Belo Horizonte - MG, CEP 31270-901, Minas Gerais, Brazil
Raquel Lima, MD
- Department of Surgery, Duke University Medical Center, Box 3704, 2400 Pratt St Ste 2500 Durham, NC 27710 Durham, NC 27710, USA
Ricardo Pietrobon, MD, PhD, MBA
- Department of Surgery, Duke University Medical Center, Box 3704, 2400 Pratt St Ste 2500 Durham, NC 27710 Durham, NC 27710, USA
Danny O. Jacobs, MD, MPH
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3077, 3423 Duke North Durham, NC 27710, USA
William Richardson, MD
- Department of Surgery, Duke University Medical Center, Box 3704, 2400 Pratt St Ste 2500 Durham, NC 27710 Durham, NC 27710, USA

Received 18 July 2006; accepted 17 September 2006. published online 02 January 2007.

Abstract

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.

Keywords: Surgical fusion, Geographic region, Length of stay, Complications, Lumbar, Charges for care