The impact of provider volume on the outcomes after surgery for lumbar spinal stenosis
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Updated: May 22, 2026
Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis
Published on: February 9, 2024
Hormuzdiyar H Dasenbrock1, Michelle J Clarke, Timothy F Witham
1Department of Neurosurgery, Brigham and Women's Hospital/Children's Hospital Boston/Harvard Medical School, Boston, Massachusetts, USA.
Background:
Investigation into the provider volume-outcomes association for patients undergoing spine surgery has been limited.
Objective:
To examine the impact of surgeon and hospital volume on the outcomes after decompression with or without fusion for lumbar spinal stenosis.
Methods:
Data from the Nationwide Inpatient Sample (2005-2008) were retrospectively extracted. Multivariate logistic regression analyses were performed to calculate the adjusted odds of in-hospital mortality and the development of a postoperative complication with increasing surgeon or hospital volume. Provider volume was evaluated continuously and categorically, divided by percentiles into quintiles. Very-low-volume surgeons performed < 15 procedures over 4 years. All analyses were adjusted for differences in patient age, sex, comorbidities, and primary payer, as well as hospital bed size, teaching status, and location (urban vs rural).
Results:
A total of 48,971 admissions were examined. In-hospital mortality did not differ significantly with increasing provider volume. When examined continuously, greater surgeon volume was associated with a significantly lower adjusted odds of developing a complication (odds ratio, 0.72; 95% confidence interval, 0.65-0.78; P < .001). Patients who underwent surgery by very-low-volume surgeons (odds ratio, 1.38; 95% confidence interval, 1.19-1.60; P = .001), but not those treated by low-, medium-, or high-volume surgeons, had a significantly higher complication rate compared with those who underwent surgery by very high-volume surgeons. After adjustment for surgeon volume, hospital volume was not significantly associated with in-hospital mortality or complications.
Conclusion:
In this nationwide study, patients treated by very-low-volume surgeons had a significantly higher complication rate compared with those treated by very high-volume surgeons.
