Volume-outcome relationship after 1 and 2 level anterior cervical discectomy and fusion.

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Volume-outcome relationship after 1 and 2 level anterior cervical discectomy and fusion.

World Neurosurg. 2017 May 19;:

Authors: De la Garza Ramos R, Nakhla J, Nasser R, Jada A, Bhashyam N, Kinon MD, Yassari R

Abstract
OBJECTIVE: To investigate the impact of surgeon volume on inpatient morbidity after 1- and 2-level anterior cervical discectomy and fusion (ACDF).
METHODS: Data from the Nationwide Inpatient Sample from 2009 were extracted. All adult patients who underwent an elective 1- or 2-level ACDF for degenerative cervical spine disease were identified. Surgeon volume was analyzed as a continuous and categorical variable (very-low (<12 procedures per year), low (12 - 23), medium (24 - 35), high (36 - 47), and very-high volume (48 or more)). A multivariate logistical regression analysis was performed to calculate the adjusted odds ratios of overall in-hospital and surgical complication occurrence in relation to surgeon volume.
RESULTS: A total of 11,249 admissions were analyzed. The overall complication rate was 4.7% and the surgical complication rate was 1.2%. Following regression analysis, increasing surgeon volume (evaluated continuously) was independently associated with lower odds of overall complication (OR 0.99; 95% CI, 0.98 - 0.99; p<0.001) and surgical complication development (OR 0.98; 95% CI, 0.97 - 0.99; p=0.004). Very-high volume surgeons (performing 48 or more procedures per year; 4 or more per month) showed a significant decrease in overall complications (OR 0.58; 95% CI, 0.41 - 0.84; p=0.003) and surgical complications (OR 0.52; 95% CI, 0.25 - 0.99; p=0.041) when compared to very-low volume surgeons.
CONCLUSION: In this study, increasing surgeon volume was independently associated with significantly lower odds of perioperative complications following 1- and 2-level ACDF. Performing 4 or more procedures per month was associated with the lowest complication rate.

PMID: 28532909 [PubMed - as supplied by publisher]

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