Navigation Links
Surgeon experience affects complication rate of spinal stenosis surgery

Philadelphia, Pa. (June 7, 2012) - For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such proceduresless than four per year, suggests a study in the June issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

In contrast, the complication rate is not significantly affected by the volume of spinal stenosis surgeries performed at the hospital, according to the new research. The senior author was Dr. Ali Bydon of Johns Hopkins Unviersity.

'Very Low' Volume Surgeons Have Higher Complication Rates

Using a large database of hospitalized patients, the researchers analyzed outcomes in nearly 49,000 patients undergoing surgery for lumbar spinal stenosisnarrowing of the spinal canal in the lower back. Rates of complications and in-hospital death were compared for surgeons and hospitals with different "volumes" of surgery for spinal stenosis from 2005 through 2008.

The volume of spinal stenosis surgeries by each surgeon was categorized from "very low" (less than 15 operations over four years) to "very high" (more than 81 procedures in four years). Hospital volume ranged from less than 68 to more than 394. These categories were compared with the risk of complications and death, with adjustment for other factors.

Complication rate ranged from 11.6 percent for patients operated on by surgeons with a very low volume of spinal stenosis surgeries to 8.6 percent for surgeons who performed a very high volume of procedures. On adjusted analysis, the risk was 38 percent higher for surgeons in the very low volume category, compared to the very high volume category. Risk was not significantly increased for surgeons at intermediate levels (low, medium, or high).

After adjustment for surgeon volume, the volume of surgeries performed at the hospital did not significantly affect complication rate. Hospital volume was also unrelated to the total cost of the procedure or the number of days spent in the hospital. Neither surgeon volume nor hospital volume significantly affected the risk of death.

For several types of relatively "high-risk" surgical procedurescoronary artery bypass graft surgery, for exampleoutcomes tend to be better when the procedure is performed by surgeons and at hospitals that perform more such procedures. Few studies have looked at how surgeon and hospital volume affect the outcomes of spine surgery. Spinal stenosis is a common cause of back pain, especially in older people. Surgery is recommended for patients who don't improve with other treatments.

The new study suggests that surgeon volume affects the risk of complications from lumbar spinal stenosis surgery. However, the difference is significant only on comparison of the lowest- versus highest-volume surgeons: averaging less than four versus more than 20 procedures per year.

Dr. Bydon and coauthors write, "[F]or patients undergoing surgery for lumbar spinal stenosis, the individual surgeon's experience, skill, and clinical knowledge may be key determinants of outcomes, whereas hospital resources may be of secondary importance." They note that most of the high- and very high-volume surgeons in their study practiced at larger, university-affiliated hospitals.

However, they also point out that more than 40 percent of these higher-volume surgeons didn't work at large university hospitalsin fact, many worked at smaller or rural hospitals. "Therefore," the researchers add, "the resources of a large academic medical center or a large, urban hospital may not be necessary for a high-volume spine surgeon."


Contact: Connie Hughes
Wolters Kluwer Health

Related medicine news :

1. NY Plastic Surgeon Challenges Long-Held Separation of Derms and Plastic Surgeons
2. Spine Surgeon from China Visits Panorama Orthopedics & Spine Center
3. Is a Tummy Tuck Right for Me? Alabama Plastic Surgeon Dr. David Durst Offers Tips as the Popularity of Surgical Cosmetic Enhancement Continues to Rise
4. Who Needs a Facelift? Plastic Surgeon Dr. Robert Zubowski With the Facts
5. Pittsburgh Neurosurgeons Explore Use of Drug that Illuminates Brain Tumor Cells To Guide Surgery
6. Ft. Lauderdale Plastic Surgeon Robert E. Rothfield MD Restoring Curves and Self-Esteem in New Moms with Mommy Makeover
7. Surgeon General with Microsoft HealthVault Expands Consumer Benefits for the My Family Health Portrait Offering
8. Dr. Alesia Wagner of U.S. HealthWorks Medical Group Re-elected to Board of Osteopathic Physicians and Surgeons of California
9. Jefferson surgeon receives outstanding performance award from American College Of Surgeons
10. Prostate cancer surgeons feel with their eyes
11. U.S. Surgeon General Regina Benjamin to Address National Association of Black Journalists Conference on Health Disparities
Post Your Comments:
(Date:12/1/2015)... ... ... The Multiple System Atrophy Coalition has announced the launch of its MSA Can’t ... today to coincide with Giving Tuesday 2015, a global day of fundraising. , ... be productive, to do simple daily activities like walking to the mailbox and eating ...
(Date:12/1/2015)... ... December 01, 2015 , ... Royal River Natural Foods — a locally-owned, ... post-menopausal women who took the nutritional supplement creatine, along with resistance training for a ... not take creatine. , The report is part of the December 2015 issue of ...
(Date:12/1/2015)... ... 2015 , ... Baptist Medical Center Jacksonville has implanted the ... hospital in the region providing what is known as the world’s smallest pacemaker. ... revealed recently at a medical conference and published in The New England Journal ...
(Date:12/1/2015)... ... December 01, 2015 , ... ... to continue the expansion of the company’s growing product line of food safety ... (Oncorhynchus tshawytscha) and Sockeye (Oncorhynchus nerka) – allow InstantLabs to offer fast, reliable ...
(Date:12/1/2015)... ... December 01, 2015 , ... ... the United States. Podiatrists are well aware that psychology-based patient non-compliance (disobedience of ... often catastrophic contributors to diseases of the diabetic foot. The American Board ...
Breaking Medicine News(10 mins):
(Date:12/1/2015)... 1, 2015  Eyeon Therapeutics has received a ... treatments based on a charged hydrophilic polymer developed ... The product has been shown to be safe ... Mark Mitchnick , MD, CEO states, "This ... additional polymers in conjunction with a therapeutic agent.  ...
(Date:12/1/2015)... 1, 2015  Athletic apparel company Tommie ... to pay $1.35 million to settle Federal Trade ... copper-infused compression clothing would relieve severe and chronic ... diseases. Tommie Copper,s proposed ... and its founder and chairman Thomas Kallish ...
(Date:12/1/2015)... diciembre de 2015  AccuTEC Blades, una ... precisión, develó hoy un nuevo logo corporativo ... El nuevo logo destaca la experiencia de ... de productos con cuchillas donde "el borde ... --> ...
Breaking Medicine Technology: