A new study published in The Spine Journal examines how inter-hospital competition affects spine surgery outcomes.
The study authors gathered data from the Nationwide Inpatient Sample covering lumbar spinal fusion procedures performed in 2003, 2006 and 2009. Researchers included 417,520 patients in the study and analyzed hospital market competitiveness using the Herfindahl-Hirschman Index. The average HHI was 0.31, and most of the patients underwent primary fusions. Study authors found:
1. Most procedures, 42.5 percent, occurred in the South; another 27 percent occurred in the Midwest.
2. Competitive intensity was associated with:
● Increased total complication rate
● Device-related complications
● Genitourinary complications
● Infection
● Neurologic complications
● Total charges
● Inpatient hospital length of stay
3. State-owned hospital complications associated more highly with HHI than private nonprofit hospitals.
4. Urban teaching hospital complications were more associated with HHI than urban nonteaching hospitals.
5. Study authors suggested a lack of resource allocation could be the reason behind different outcomes related to hospital competition. "Identifying differences in perioperative outcomes associated with hospital market competition is important in the contemporary environment of healthcare reimbursement reform and hospital consolidation," concluded the study authors.