How Many Spine Surgeries Qualify a Surgeon as “Experienced”?

A group of Boston researchers set out to determine volume benchmarks for the four commons lumbar spine surgeries—discectomy, decompression, lumbar interbody fusion, and lumbar posterolateral fusion.

The study, “Establishing benchmarks for the volume-outcome relationship for common lumbar spine surgical procedures,” is published in the January 2018 edition of The Spine Journal.

Co-author Andrew J. Schoenfeld, M.D., M.Sc., with the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, Harvard Medical School told OTW, “We are increasingly recognizing the importance of volume-outcomes relationships in various surgical disciplines.”

“To define these correctly, however, we must ensure that the measures used are not only valid but determined objectively. We are among the first to describe this relationship in an objective fashion for lumbar spine procedures.”

“As described in the text, we used a spline analysis which is an objective means of defining volume-outcome relationships based on the assessment of the relationship between surgical volume and complications as well as readmissions. We were also able to achieve these assessments for lumbar interbody fusion, posterolateral fusion, decompression and discectomy separately.”

“Based on our determinations, readily achievable goals for surgeons would include roughly four discectomy and lumbar interbody fusion procedures per month, three posterolateral lumbar fusions per month and at least one decompression surgery every other week.”

The authors wrote, “In all, 187,185 spine surgical procedures met inclusion criteria, performed by 5,514 surgeons at 178 hospitals. Spline analysis determined that the procedure volume cut-point was 25 for decompressions, 40 for discectomy, 43 for interbody fusion, and 35 for posterolateral fusions.”

“For surgeons who failed to meet the volume metric, there was a 63% increase in the risk of complications following decompressions, a 56% increase in the risk of complications following discectomy, a 15% increase in the risk of complications following lumbar interbody fusions, and a 47% increase in the risk of complications following posterolateral fusions. Findings were similar for readmission measures.”

“The results of this work have allowed us to identify potentially meaningful volume-based benchmarks for the performance of common lumbar spine surgical procedures including decompression, discectomy and fusion-based procedures. While these measures can be immediately used as benchmarks for individual surgeons within their own practice, further external validation is necessary before a policy-based application is feasible.”

“Our effort relied on data from the Florida Inpatient Dataset, a widely used registry from a state with a large and diverse population of patients, medical centers and providers that enables broad generalization of our findings to surgical practices across the United States.”