Does the ranking of surgeons in a publicly available online platform correlate with objective outcomes?

OBJECTIVEThe accuracy of public reporting in health care, especially from private vendors, remains an issue of debate. The authors investigated the association of the publicly reported physician complication rates in an online platform with real-world adverse outcomes of the same physicians for patients undergoing posterior lumbar fusion.METHODSThe authors performed a cohort study involving physicians performing posterior lumbar fusions between 2009 and 2013 who were registered in the Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data over the same time period from ProPublica, a private company. Mixed-effects multivariable regression models were used to investigate the association of publicly available complication rates with the rate of discharge to a rehabilitation facility, length of stay, mortality, and hospitalization charges for the same surgeons.RESULTSDuring the selected study period, there were 8,457 patients in New York State who underwent posterior lumbar fusion performed by the 56 surgeons represented in the ProPublica Surgeon Scorecard over the same time period. Using a mixed-effects multivariable regression model, the authors demonstrated that publicly reported physician-level complication rates were not associated with the rate of discharge to a rehabilitation facility (OR 0.97, 95% CI 0.72–1.31), length of stay (adjusted difference −0.1, 95% CI −0.5 to 0.2), mortality (OR 0.87, 95% CI 0.49–1.55), and hospitalization charges (adjusted difference $18,735, 95% CI −$59,177 to $96,647). Similarly, no association was observed when utilizing propensity score–adjusted models, and when restricting the cohort to a predefined subgroup of Medicare patients.CONCLUSIONSAfter merging a comprehensive all-payer posterior lumbar fusion cohort in New York State with data from the ProPublica Surgeon Scorecard over the same time period, the authors observed no association of publicly available physician complication rates with objective outcomes.

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How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?

Journal of Neurosurgery Spine ◽

10.3171/2016.1.spine151155 ◽

2016 ◽

Vol 25 (2) ◽

pp. 264-270 ◽

Cited By ~ 14

Author(s):

Symeon Missios ◽

Kimon Bekelis

Keyword(s):

New York ◽

Regression Analysis ◽

Patient Satisfaction ◽

Spine Surgery ◽

New York State ◽

Mixed Effects ◽

Public Reporting ◽

Objective Outcomes ◽

Satisfaction Measures ◽

Hospital Compare

OBJECTIVE The accuracy of public reporting in health care is an issue of debate. The authors investigated the association of patient satisfaction measures from a public reporting platform with objective outcomes for patients undergoing spine surgery. METHODS The authors performed a cohort study involving patients undergoing elective spine surgery from 2009 to 2013 who were registered in the New York Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. A mixed-effects regression analysis, controlling for clustering at the hospital level, was used to investigate the association of patient satisfaction metrics with outcomes. RESULTS During the study period, 160,235 patients underwent spine surgery. Using a mixed-effects multivariable regression analysis, the authors demonstrated that undergoing elective spine surgery in hospitals with a higher percentage of patient-assigned high satisfaction scores was not associated with a decreased rate of discharge to rehabilitation (OR 0.77, 95% CI 0.57–1.06), mortality (OR 0.96, 95% CI 0.90–1.01), or hospitalization charges (β 0.04, 95% CI −0.16 to 0.23). However, it was associated with decreased length of stay (LOS; β −0.19, 95% CI −0.33 to −0.05). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others. CONCLUSIONS Merging a comprehensive all-payer cohort of spine surgery patients in New York state with data from the CMS Hospital Compare website, the authors were not able to demonstrate an association of improved performance in patient satisfaction measures with decreased mortality, rate of discharge to rehabilitation, and hospitalization charges. Increased patient satisfaction was associated with decreased LOS.

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Correlation of Subjective Hospital Compare Metrics With Objective Outcomes of Cranial Neurosurgical Procedures in New York State

Neurosurgery ◽

10.1093/neuros/nyw071 ◽

2017 ◽

Vol 80 (3) ◽

pp. 401-408 ◽

Cited By ~ 4

Author(s):

Kimon Bekelis ◽

Symeon Missios ◽

Shannon Coy ◽

Redi Rahmani ◽

Todd A. MacKenzie ◽

...

Keyword(s):

New York ◽

New York State ◽

Neurosurgical Procedures ◽

York State ◽

Objective Outcomes ◽

Hospital Compare

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Emergency department evaluation and 30-day readmission after craniotomy for primary brain tumor resection in New York State

Journal of Neurosurgery ◽

10.3171/2016.9.jns161575 ◽

2017 ◽

Vol 127 (6) ◽

pp. 1213-1218 ◽

Cited By ~ 2

Author(s):

Symeon Missios ◽

Kimon Bekelis

Keyword(s):

New York ◽

Brain Tumor ◽

New York State ◽

Tumor Resection ◽

Primary Brain Tumor ◽

Mixed Effects ◽

York State ◽

Brain Tumor Resection ◽

Original Procedure ◽

Adjusted Model

OBJECTIVEFragmentation of care has been recognized as a major contributor to 30-day readmissions after surgical procedures. The authors investigated the association of evaluation in the hospital where the original procedure was performed with the rate of 30-day readmissions for patients presenting to the emergency department (ED) after craniotomy for primary brain tumor resection.METHODSA cohort study was conducted, involving patients who were evaluated in the ED within 30 days after discharge following a craniotomy for primary brain tumor resection between 2009 and 2013, and who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database of New York State. A propensity score–adjusted model was used to control for confounding, whereas a mixed-effects model accounted for clustering at the hospital level.RESULTSOf the 610 patients presenting to the ED, 422 (69.2%) were evaluated in a hospital different from the one where the original procedure was performed (28.9% were readmitted), and 188 (30.8%) were evaluated at the original hospital (20.3% were readmitted). In a multivariable analysis, the authors demonstrated that being evaluated in the ED of the original hospital was associated with a decreased rate of 30-day readmission (OR 0.64, 95% CI 0.41–0.98). Similar associations were found in a mixed-effects logistic regression model (OR 0.63, 95% CI 0.40–0.96) and a propensity score–adjusted model (OR 0.64, 95% CI 0.41–0.98). This corresponds to one less readmission per 12 patients evaluated in the hospital where the original procedure was performed.CONCLUSIONSUsing a comprehensive all-payer cohort of patients in New York State who were evaluated in the ED after craniotomy for primary brain tumor resection, the authors identified an association of assessment in the hospital where the original procedure was performed with a lower rate of 30-day readmissions. This underscores the potential importance of continuity of care in readmission prevention for these patients.

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National Complication Rates and Disposition After Posterior Lumbar Fusion for Acquired Spondylolisthesis

Spine ◽

10.1097/brs.0b013e3181ae2243 ◽

2009 ◽

Vol 34 (18) ◽

pp. 1963-1969 ◽

Cited By ~ 120

Author(s):

Paul S. Kalanithi ◽

Chirag G. Patil ◽

Maxwell Boakye

Keyword(s):

Lumbar Fusion ◽

Complication Rates ◽

Posterior Lumbar Fusion

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Impact of Age on Short-term Outcomes After Lumbar Fusion

Neurosurgery ◽

10.1227/neu.0000000000000852 ◽

2015 ◽

Vol 77 (3) ◽

pp. 347-354 ◽

Cited By ~ 21

Author(s):

Mohamad Bydon ◽

Nicholas B. Abt ◽

Rafael De la Garza-Ramos ◽

Israel O. Olorundare ◽

Kelly McGovern ◽

...

Keyword(s):

Lumbar Fusion ◽

Multivariable Analysis ◽

The Elderly ◽

Complication Rates ◽

Improvement Program ◽

Younger Patients ◽

Age Cohorts ◽

Significant Difference ◽

Age Cohort ◽

Multivariable Regression

Abstract BACKGROUND: The safety and efficacy of spinal fusion in the elderly population remains uncertain with conflicting data. OBJECTIVE: To determine if elderly patients undergoing instrumented lumbar fusion have increased 30-day complication rates compared to younger patients. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was used to identify all patients undergoing instrumented posterolateral lumbar fusion between 2005 and 2011. Patients were stratified by decade cohorts as follows: <65, 65 to 75, 75 to 85, and ≥85 years old. All 30-day complications were grouped as overall composite morbidity and were compared using multivariate analysis. RESULTS: A total of 1395 patients were identified and the overall 30-day complication rate was 11.47%. The complication rates were 9.04% and 14.05% for patients younger than 65 and older than 65, respectively. When stratified by decade cohorts, the complication rates were 9.04% for the <65 cohort, 13.46% for the 65 to 75 cohort, 16.17% for the >75 to 85 cohort, and 4.00% for the ≥85 cohort. Multivariable regression analysis revealed no statistically significant difference between the <65 and ≥65 age cohorts (odds ratio = 1.26; 95% confidence interval: 0.87-2.19). After stratifying into age cohorts, multivariable analyses revealed no difference in odds of postoperative complication occurrence for any age cohort when compared with the referent group (<65 years of age). CONCLUSION: Patients older than 65 years of age have significantly higher rates of complications after lumbar fusion when compared to younger patients. However, multivariable analysis revealed that age was not an independent risk factor for complication occurrence after lumbar fusion.

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The impact of bisphosphonates on postoperative complication rates in osteoporotic patients undergoing posterior lumbar fusion

European Spine Journal ◽

10.1007/s00586-020-06706-y ◽

2021 ◽

Author(s):

Sidney Roberts ◽

Blake Formanek ◽

Zorica Buser ◽

Jeffrey C. Wang

Keyword(s):

Postoperative Complication ◽

Lumbar Fusion ◽

Complication Rates ◽

Posterior Lumbar Fusion ◽

The Impact

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Diabetes Is Predictive of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion

Global Spine Journal ◽

10.1177/2192568220948480 ◽

2020 ◽

pp. 219256822094848

Author(s):

Annie E. Arrighi-Allisan ◽

Sean N. Neifert ◽

Jonathan S. Gal ◽

Lawrence Zeldin ◽

Jeffrey H. Zimering ◽

...

Keyword(s):

Emergency Room ◽

Emergency Room Visit ◽

Lumbar Fusion ◽

Significant Risk ◽

Significant Risk Factor ◽

Adverse Outcomes ◽

Complication Rates ◽

Posterior Lumbar Fusion ◽

Prolonged Length ◽

Comorbidity Burden

Study Design: Retrospective cohort study. Objective: The present study analyzes complication rates and episode-based costs for patients with and without diabetes mellitus (DM) following posterior lumbar fusion (PLF). Methods: PLF cases at a single institution from 2008 to 2016 were queried (n = 3226), and demographic and perioperative data were analyzed. Patients with and without the diagnosis of DM were compared using chi-square, Student’s t test, and multivariable regression modeling. Results: Patients with diabetes were older (63.10 vs 56.48 years, P < .001) and possessed a greater number of preoperative comorbidities (47.84% of patients had Elixhauser Comorbidity Index >0 vs 42.24%, P < .001) than did patients without diabetes. When controlling for preexisting differences, diabetes remained a significant risk factor for prolonged length of stay (OR = 1.59, 95% CI 1.26-2.01, P < .001), intensive care unit stay (OR = 1.52, 95% CI 1.07-2.17, P = .021), nonhome discharge (OR = 1.86, 95% CI 1.46-2.37, P < .001), 30-day readmission (OR = 2.15, 95% CI 1.28-3.60, P = .004), 90-day readmission (OR = 1.65, 95% CI 1.05-2.59, P = .031), 30-day emergency room visit (OR = 2.15, 95% CI 1.27-3.63, P = .004), and 90-day emergency room visit (OR = 2.27, 95% CI 1.41-3.65, P < .001). Cost modeling controlling for overall comorbidity burden demonstrated that diabetes was associated with a $1709 increase in PLF costs (CI $344-$3074, P = .014). Conclusions: The present findings indicate a correlation between diabetes and a multitude of postoperative adverse outcomes and increased costs, thus illustrating the substantial medical and financial burdens of diabetes for PLF patients. Future studies should explore preventive measures that may mitigate these downstream effects.

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Six-year Burden of Care for Nonsyndromic Unilateral Cleft Lip and Palate Patients: A Comparison Between Cleft Centers and Noncleft Centers

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211053768 ◽

2021 ◽

pp. 105566562110537

Author(s):

Pierce L. Janssen ◽

Kanad Ghosh ◽

Gabriel M. Klein ◽

Wei Hou ◽

Christopher S. Bellber ◽

...

Keyword(s):

New York ◽

Length Of Stay ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Hospital Admissions ◽

New York State ◽

Complication Rates ◽

Burden Of Care ◽

Average Hospital

Objective To determine differences in burden of care between nonsyndromic patients with unilateral cleft lip and palate undergoing treatment at American Cleft Palate-Craniofacial Association (ACPA)-accredited centers and nonaccredited centers in New York State. Design A retrospective review of the New York Statewide Planning and Research Cooperative System database from January 2001 to December 2014 was performed using ICD-9 and CPT coding. Patients, participants This study included patients with unilateral cleft lip and palate who underwent both lip and palate repairs during their first 6 years of life. Exclusion criteria included orofacial cleft syndromes, follow-up under 6 years, and one-stage combined cleft lip and palate repairs. Results Eighty-eight patients were treated at cleft centers, and 29 patients at nonaccredited centers ( n = 117). Age at primary palatoplasty (13.0 months vs 18.1 months; p = .019), total number of cleft operations (2.3 vs 2.7; p = .012), and total number of primary cleft-specific procedures (2.2 vs 2.5; p = .0049) were significantly lower for patients treated in cleft centers. Age at primary cheiloplasty (4.8 months vs 4.6 months; p = .865), post-cheiloplasty length of stay (1.2 days vs 1.2 days; p = .673), post-palatoplasty length of stay (1.5 days vs 1.9 days; p = .211), average hospital admissions (2.2 vs 2.3; p = 0.161), and total complication rates (34.1% vs 21.1%; p = 0.517) did not differ significantly between cleft centers and noncenters. Conclusions This data demonstrates some significant differences in overall 6 year burden of care for nonsyndromic patients with unilateral cleft lip and palate treated at ACPA-accredited cleft centers versus nonaccredited centers.

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