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    Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

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    Author
    Weir, T.B.
    Sardesai, N.
    Jauregui, J.J.
    Sokolow, M.J.
    Usmani, M.F.
    Camacho, J.E.
    Banagan, K.E.
    Koh, E.Y.
    Davis, R.F.
    Gelb, D.E.
    Ludwig, S.C.
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    Date
    2020
    Journal
    Global Spine Journal
    Publisher
    SAGE Publications Ltd
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1177/2192568219848666
    Abstract
    Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions (P <.001) per level fused; the CH performed more interbody fusions (P =.007). Cost of performing microdiscectomy (P <.001) and laminectomy (P =.014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy (P <.001) and laminectomy with single-level fusion (P <.001), but trended toward significance for laminectomy without fusion (P =.052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH (P =.019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive. Copyright The Author(s) 2019.
    Sponsors
    AO North America, AONA; National Institutes of Health, NIH
    Keyword
    community hospital
    complication
    cost
    elective spine surgery
    lumbar microdiscectomy
    readmissions
    surgical setting
    tertiary hospital
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85084543419&doi=10.1177%2f2192568219848666&partnerID=40&md5=f85ad9758b2f692a90d00d20d75f0c26; http://hdl.handle.net/10713/12826
    ae974a485f413a2113503eed53cd6c53
    10.1177/2192568219848666
    Scopus Count
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    UMB Open Access Articles 2020

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