A new study published in Spine examines the costs associated with anterior cervical fusions based on the volume of procedures the surgeon performs.
The study authors examined 419,212 patients with data in the Nationwide Inpatient Sample who underwent surgery from 2003 to 2009. The patients were divided into three groups: those who underwent surgery from surgeons with volume under the 25th percentile, 25 to 74the percentile or at the 75th percentile and above.
The surgeons at the 25th percentile performed around five anterior cervical fusions per year, compared to 67 procedures for surgeons at the 75th percentile. The researchers found:
1. The surgeons who performed the fewest procedures were associated with increased adverse events and multiple complications, including death. The surgeons below the 25th percentile in volume also reported increased rates of myocardial infarction, sepsis and surgical site infection.
2. The surgeons whose volume was at the 75th percentile or above were associated with fewer adverse events and deaths.
3. The surgeons who were under the 25th percentile were associated with an increased length of stay; their patients stayed at the hospital 2.3 days longer on average. The surgeons at the 75th percentile or greater were associated with 0.3 days shorter patient stays.
4. Surgeons under the 25th percentile were associated with $4,569 higher hospital costs while surgeons at or above the 75th percentile were associated with $1,213 lower costs per procedure.
5. The study authors concluded surgeons at the 75th percentile volume or above "experienced decreased complications, length of stay and costs."