Geographic variation in lumbar fusion for degenerative disorders

1990 to 2000

Chad Cook, Guilherme Cunha M Santos, Raquel Lima, Ricardo Pietrobon, Danny O. Jacobs, William Richardson

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Background context: Past studies have shown that proportion of lumbar fusion surgery to all forms of lumbar surgery is variable among geographic regions. At present, no studies have investigated whether fusion outcome is associated with geographic region. Purpose: The purpose of this study was to examine the postoperative complication rate, postoperative mortality rate, hospital length of stay (LOS), hospital routine discharge rate, and total charges associated with surgical care across the geographic regions. Study design/setting: Retrospective cohort study using national sample administrative data. Patient sample: The study included 23,143 patients who underwent lumbar spine fusion surgery with a principal diagnosis of lumbar spine disease related to degeneration. Outcome measures: Functional measures included complication rate, mortality rate, and hospital LOS; routine discharge; and total charges for care. Methods: Selected variables from the Nationwide Inpatient Sample database were used for comparison across the geographic regions of the South, Midwest, Northeast, and West. Bivariate statistical analyses compared postoperative complication rates, mortality rates, hospital LOS, routine discharge rate, and total charges associated with surgical care across the geographic regions. Results: Significant differences in routine discharge (p<.001), cauda equina complications (p=.001), LOS (p<.001), and inflation-adjusted charges (p<.001) were found for the South and the West (demonstrated lower routine discharges and higher rates of complications involving cauda equina syndromes) and the Northeast and the Midwest (involved higher LOS than the South and the West but lower reported charges after adjustments for inflation). Conclusions: The findings suggest that surgical fusion outcome is associated with regional variations. It is likely that patient selection and physician preferences are associated with these findings. Similar to variations in proportion of lumbar fusion surgery among geographic regions, outcomes for surgical fusions also vary across regions.

Original languageEnglish (US)
Pages (from-to)552-557
Number of pages6
JournalSpine Journal
Volume7
Issue number5
DOIs
StatePublished - Sep 2007
Externally publishedYes

Fingerprint

Length of Stay
Economic Inflation
Mortality
Spine
Polyradiculopathy
Cauda Equina
Patient Selection
Inpatients
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Databases
Physicians

Keywords

  • Charges for care
  • Complications
  • Geographic region
  • Length of stay
  • Lumbar
  • Surgical fusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Cook, C., Santos, G. C. M., Lima, R., Pietrobon, R., Jacobs, D. O., & Richardson, W. (2007). Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000. Spine Journal, 7(5), 552-557. https://doi.org/10.1016/j.spinee.2006.09.010

Geographic variation in lumbar fusion for degenerative disorders : 1990 to 2000. / Cook, Chad; Santos, Guilherme Cunha M; Lima, Raquel; Pietrobon, Ricardo; Jacobs, Danny O.; Richardson, William.

In: Spine Journal, Vol. 7, No. 5, 09.2007, p. 552-557.

Research output: Contribution to journalArticle

Cook, C, Santos, GCM, Lima, R, Pietrobon, R, Jacobs, DO & Richardson, W 2007, 'Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000', Spine Journal, vol. 7, no. 5, pp. 552-557. https://doi.org/10.1016/j.spinee.2006.09.010
Cook C, Santos GCM, Lima R, Pietrobon R, Jacobs DO, Richardson W. Geographic variation in lumbar fusion for degenerative disorders: 1990 to 2000. Spine Journal. 2007 Sep;7(5):552-557. https://doi.org/10.1016/j.spinee.2006.09.010
Cook, Chad ; Santos, Guilherme Cunha M ; Lima, Raquel ; Pietrobon, Ricardo ; Jacobs, Danny O. ; Richardson, William. / Geographic variation in lumbar fusion for degenerative disorders : 1990 to 2000. In: Spine Journal. 2007 ; Vol. 7, No. 5. pp. 552-557.
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