340 Trends and Disparities in Cervical Spine Fusion Procedure Utilization in the New York State

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 276-276
Author(s):  
Rui Feng ◽  
Mark Finkelstein ◽  
Eric Karl Oermann ◽  
Michael Palese ◽  
John M Caridi
Keyword(s):  
New York ◽  
African American ◽  
Cervical Spine ◽  
New York State ◽  
High Volume ◽  
Spine Fusion ◽  
York State ◽  
High Volume Hospital ◽  
Low Volume ◽  
Cervical Spine Fusion

Abstract INTRODUCTION There has been a steady increase in spinal fusion procedures performed each year in the US, especially cervical and lumbar fusion. Our study aims to analyze the rate of increase at low-, medium-, and high-volume hospitals, and socioeconomic characteristics of the patient populations at these three volume categories. METHODS We searched the New York State, Statewide Planning and Research Cooperative System (SPARCS) database from 2005 to 2014 for the ICD-9-CM Procedure Codes 81.01 (Fusion, atlas-axis), 81.02 (Fusion, anterior column, other cervical, anterior technique), and 81.03 (Fusion, posterior column, other cervical, posterior technique). Patients' primary diagnosis (ICD-9-CM), age, race/ethnicity, primary payment method, severity of illness, length of stay, hospital of operation were included. We categorized all 122 hospitals high-, medium-, and low-volume. We then described the trends in annual number of cervical spine fusion surgeries in each of the three hospital volume groups using descriptive statistics. RESULTS >African American patients were significantly greater portion of patients receiving care at low-volume hospitals, 15.1% versus 11.6% at high-volume hospital. Medicaid and self-pay patients were also overrepresented at low-volume centers, 6.7% and 3.9% versus 2.6% and 1.7% respectively at high-volume centers. In addition, Compared with Caucasian patients, African American patients had higher rates of post-operative infection (P = 0.0020) and post-operative bleeding (P = 0.0044). Compared with privately insured patients, Medicaid patients had a higher rate of post-operative bleeding (P = 0.0266) and in-hospital mortality (P = 0.0031). CONCLUSION Our results showed significant differences in racial distribution and primary payments methods between the low- and high-volume categories, and suggests that accessibility to care at high-volume centers remains problematic for these disadvantaged populations.

Trends and Disparities in Cervical Spine Fusion Procedures Utilization in the New York State

Spine ◽  
2018 ◽  
Vol 43 (10) ◽  
pp. E601-E606 ◽  
Author(s):  
Rui Feng ◽  
Mark Finkelstein ◽  
Khawaja Bilal ◽  
Eric K. Oermann ◽  
Michael Palese ◽  
...  
Keyword(s):  
New York ◽  
Cervical Spine ◽  
New York State ◽  
Spine Fusion ◽  
York State ◽  
Cervical Spine Fusion

The Regionalization of Total Ankle Arthroplasties and Ankle Fusions in New York State: A 10-Year Comparative Analysis

2016 ◽  
Vol 10 (3) ◽  
pp. 210-215 ◽  
Author(s):  
John A. Buza ◽  
James X. Liu ◽  
Jeffrey Jancuska ◽  
Joseph A. Bosco
Keyword(s):  
New York ◽  
New York State ◽  
High Volume ◽  
Case Control ◽  
Cooperative System ◽  
York State ◽  
State Institutions ◽  
Statewide Planning ◽  
Low Volume ◽  
Zip Code

Background. Total ankle arthroplasty (TAA) provides an alternative to ankle fusion (AF). The purpose of this study is to (1) determine the extent of TAA regionalization, as well as examine the growth of TAA performed at high-, medium-, and low-volume New York State institutions and (2) compare this regionalization and growth with AF. Methods. The New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 737 primary TAA and 7453 AF from 2005 to 2014. The volume of TAA and AF surgery in New York State was mapped according to patient and hospital 3-digit zip code. Results. The number of TAA per year grew 1500% (from 11 to 177) from 2005 to 2014, while there was a 35.6% reduction (from 895 to 576) in yearly AF procedures. TAA recipients were widely distributed throughout the state, while TAA procedures were regionalized to a few select metropolitan centers. AF procedures were performed more uniformly than TAA. The number of TAA has continued to increase at high- (15 to 91) and medium-volume (14 to 67) institutions where it has decreased at low-volume institutions (44 to 19). Conclusion. The increased utilization of TAA is attributed to relatively few high-volume centers located in major metropolitan centers. Levels of Evidence: Level IV: well-designed case-control or cohort studies

MP27-12 HIGH VOLUME SURGEONS ARE ASSOCIATED WITH LOWER COST OF RADICAL PROSTATECTOMY IN NEW YORK STATE

2020 ◽  
Vol 203 ◽  
pp. e414-e415
Author(s):  
Zhan Wu* ◽  
Christopher Haas ◽  
Jun Lu ◽  
Gen Li ◽  
Elias Hyams
Keyword(s):  
New York ◽  
Radical Prostatectomy ◽  
Lower Cost ◽  
New York State ◽  
High Volume ◽  
York State

The Diffusion of Two Diagnostic Technologies among Hospitals in New York State

1988 ◽  
Vol 4 (4) ◽  
pp. 593-600 ◽  
Author(s):  
Cynthia Carter Haddock ◽  
James W. Begun
Keyword(s):  
New York ◽  
New York State ◽  
High Volume ◽  
Logistic Function ◽  
Ct Scanner ◽  
American Hospital ◽  
American Hospital Association ◽  
York State ◽  
Early Adoption ◽  
Diagnostic Technologies

Using combined data from an independent survey by the American Hospital Association and the State of New York, the diffusion of two diagnostic technologies–the automated chemistry analyzer and the computed tomography (CT) scanner–among hospitals in New York State was analyzed. A linearized form of the logistic function was estimated using cumulative diffusion data for each. Diffusion patterns of both technologies fit the logistic curve well, with the coefficient of diffusion for the CT scanner being greater than that for the automated analyzer. Further analysis examined characteristics of early adopters of each technology. Similar hospital characteristics (e.g., high volume of admissions and medical school affiliation) were important in explaining early adoption of both technologies.

Impact of marital status on colorectal cancer (CRC) disease-specific survival in New York state.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18084-e18084 ◽  
Author(s):  
Carla Francesca Justiniano ◽  
Zhaomin Xu ◽  
Adan Z Becerra ◽  
Christopher Thomas Aquina ◽  
Francis P. Boscoe ◽  
...  
Keyword(s):  
New York ◽  
Marital Status ◽  
New York State ◽  
High Volume ◽  
Smoking History ◽  
York State ◽  
Never Married ◽  
Risk Of Death ◽  
Additional Support ◽  
The Impact

e18084 Background: CRC is the second leading cause of cancer death in the US. Social support and financial resources vary by marital status. This study analyzes the impact of marital status by sex on survival after resection for CRC. Methods: The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for 2004-2013 colectomy or proctectomy Stage I-III CRC patients and categorized by marital status: single/never married (single), married/domestic partner (married), and widowed/separated/divorced (previously married). Competing risk analysis of 5-year mortality was executed adjusting for patient (age at diagnosis, sex, race, Medicaid, income, marital status, smoking history, comorbidities, year of diagnosis, and stage), treatment (scheduled surgery and complications, chemotherapy, radiation), surgeon (colorectal board, volume), and hospital factors (volume, academic, rural). Results: 38,020 (colon 32,451, rectal 5,569) met inclusion criteria, of which 28% died within 5 years. Single patients were more likely than married to be current smokers (17 vs 12%), be on Medicaid (42 vs 27%) and present emergently (38 vs 25%), and less likely to be treated by high volume surgeons (32 vs 40%). Married patients had decreased risk of 5-year CRC-specific mortality (hazard ratio [HR] 0.86, confidence interval [CI] 0.80-0.94) vs single. When stratified by sex, married males had a decreased risk of death but married females did not and this persists if stratified by colon vs rectum (Table). Income was not significantly associated with survival and previously married patients did not significantly differ from single. Conclusions: Marital status impacts CRC-specific survival in males and females differently. Married men have a protective effect from marriage, whereas married females do not and may benefit from additional support throughout their cancer care. [Table: see text]

Evaluation of Trends in the Use of InterStim for Fecal Incontinence

2017 ◽  
Vol 24 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Jonathan S. Abelson ◽  
Joshua D. Spiegel ◽  
Heather L. Yeo ◽  
Jialin Mao ◽  
Tianyi Sun ◽  
...  
Keyword(s):  
New York ◽  
Fecal Incontinence ◽  
New York State ◽  
Geographic Location ◽  
High Volume ◽  
Clinical Problem ◽  
White Female ◽  
Device Removal ◽  
York State ◽  
Patterns Of Use

Background: Fecal incontinence (FI) represents a large source of morbidity and is a challenging clinical problem to manage. InterStim was approved to treat FI in 2011. Little is known about its adoption. We sought to characterize patterns of use of Interstim since Food and Drug Administration approval for FI. Methods: The New York State SPARCS database was used to evaluate InterStim use for FI from 2011 to 2014. The primary endpoint was the number of successful implantations of InterStim. Secondary endpoints included device removal, median time to removal of device, 90-day infection rates, and percentage of procedures performed by surgeon specialty and geographic location. Results: A total of 369 patients with FI underwent “Stage 1” of InterStim from 2011 to 2014. A total of 302 patients underwent “Stage 2,” yielding a trial period failure rate of 18.2%. The majority of patients who underwent successful implantation were female (87.7%) and White (78.8%). Twenty-nine patients underwent device removal after a median duration of 147 days. Estimated risk of removal at median follow-up of 2 years was 11.8%. Colorectal surgeons comprised 51.1% of all providers followed by gynecologic (24.4%) and urologic surgeons (17.8%). A total of 71.7% of providers performed <5 procedures, while 3 of the highest volume providers performed 50.7% of all procedures. Conclusions: InterStim for FI has been used by a wide variety of providers in New York State although only a few high-volume providers have performed the majority of procedures. White, female patients with Medicare are the most common recipients of InterStim. Further work must be done to develop strategies for improving access to this technology and to determine whether volume relates to outcomes.

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