Surgery center influences outcomes in spinal surgery

Atman Desai, M.D., from the Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and colleagues retrospectively reviewed data from 793 participants in the Spine Patient Outcomes Research Trial with a confirmed diagnosis of lumbar stenosis or degenerative spondylolisthesis undergoing surgery. Patients were followed from baseline and outcomes were assessed at six weeks, and three, six, and 12 months, and yearly thereafter, at 13 spine clinics throughout the United States.

The researchers found significant differences between centers with regard to patient race, body mass index, treatment preference, neurological deficit, stenosis location and severity, and number of stenotic levels. In addition, they noted significant differences in operative duration and blood loss, the incidence of durotomy, the length of hospital stay, and wound infection. Even after adjustment for baseline differences, there were still significant differences between centers in changes in patient functional outcome (Short Form-36 [SF-36] bodily pain and physical function and Oswestry disability index) at one year after surgery. At four years after surgery, the Oswestry disability index score was still significantly different among centers, and the SF-36 scores trended toward significance.

"There is broad and statistically significant variation in short- and long-term outcomes after surgery for lumbar stenosis and degenerative spondylolisthesis across various academic centers, when statistically significant baseline differences are adjusted for," the authors write. "The findings suggest choice of center affects outcome after these procedures, although further studies are required to investigate which center characteristics are most important."

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Journal reference: Spine

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