Objective Increased surgical volume has been associated with improved patient outcomes at the surgeon and hospital level. To date, clinically meaningful stratified volume benchmarks have yet to be defined for surgeons or hospitals in the context of spinal fusion surgery. The objective of this study was to establish evidence-based thresholds using outcomes and cost to stratify surgeons and hospitals performing spinal fusion surgery by volume.
Methods Using 155,788 patients undergoing spinal fusion surgery, we created and applied 4 models using stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve. This statistical approach was used to generate 4 sets of volume thresholds predictive of increased length of stay (LOS) and increased cost for surgeons and hospitals.
Results SSLR analysis of the 2 ROC curves by annual surgical volume produced 3 or 4 distinct volume categories. Analysis of LOS by annual surgeon spinal fusion volume produced 4 strata: low, medium, high, and very high. Analysis of LOS by annual hospital spinal fusion volume produced 3 strata: low, medium, and high. No relationship between volume and cost could be clearly defined based on the generation of ROC curves for surgeons or hospitals offering spinal fusion.
Conclusion This study used evidence-based thresholds to identify a direct, variable relationship model between volume and outcomes of spinal fusion surgery, using LOS as a surrogate, for both surgeons and hospitals. A fixed relationship model was identified between surgeon and hospital volume and cost, as no statistically meaningful relationship could be established.
Citations
Citations to this article as recorded by
Optimising postoperative spine outcomes: an umbrella review of enhanced recovery after spinal surgery (ERASS) protocols Daniel Sescu, Devika Dahiya, Laura Scaramuzzo, Stipe Corluka, Sathish Muthu, Samuel K. Cho, Zorica Buser, Tim Sangwook Yoon, Andreas K. Demetriades British Journal of Anaesthesia.2025; 135(6): 1663. CrossRef
Surgeon Volume and Social Disparity are Associated with Postoperative Complications After Lumbar Fusion Peter G. Brodeur, Giancarlo Medina Perez, Davis A. Hartnett, Christopher L. McDonald, Joseph A. Gil, Aristides I. Cruz, Eren O. Kuris World Neurosurgery.2022; 163: e162. CrossRef
An Employer-Provider Direct Payment Program Is Associated With Lower Episode Costs Christopher M. Whaley, Christoph Dankert, Michael Richards, Dena Bravata Health Affairs.2021; 40(3): 445. CrossRef
Experimental Comparison of Autograft and DBM Flex (Grafton) for Spinal Lumbar Fusion in Rabbits Cem DEMİREL, Dursun TÜRKÖZ, Tuncay YİLMAZ Archives of Clinical and Experimental Medicine.2021; 6(3): 153. CrossRef
Can a machine learning model accurately predict patient resource utilization following lumbar spinal fusion? Jaret M. Karnuta, Joshua L. Golubovsky, Heather S. Haeberle, Prashant V. Rajan, Sergio M. Navarro, Atul F. Kamath, Jonathan L. Schaffer, Viktor E. Krebs, Dominic W. Pelle, Prem N. Ramkumar The Spine Journal.2020; 20(3): 329. CrossRef
Defining the Volume-Outcome Relationship in Reverse Shoulder Arthroplasty Kevin X. Farley, Andrew M. Schwartz, Susanne H. Boden, Charles A. Daly, Michael B. Gottschalk, Eric R. Wagner Journal of Bone and Joint Surgery.2020; 102(5): 388. CrossRef
Comparison of Fusion Rate between Demineralized Bone Matrix versus Autograft in Lumbar Fusion : Meta-Analysis Sanghyun Han, Bumsoo Park, Jeong-Wook Lim, Jin-Young Youm, Seoung-Won Choi, Dae Hwan Kim, Dong Ki Ahn Journal of Korean Neurosurgical Society.2020; 63(6): 673. CrossRef
Optimizing the Volume–Value Relationship in Laminectomy William C. Frankel, Sergio M. Navarro, Heather S. Haeberle, Deepak Ramanathan, Prem N. Ramkumar Spine.2019; 44(9): 659. CrossRef
First
Prev
