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Variability in spinal surgery outcomes among children's hospitals in the United States
Mark A Erickson1, Elaine H Morrato, Elizabeth J Campagna
1Department of Orthopedic Surgery, Children's Hospital Colorado, CO 80045, USA.
Insights
Outcomes for pediatric spinal surgery vary significantly between children's hospitals. Neurologically impaired children face higher infection and complication risks, highlighting the need for quality improvement initiatives.
Area of Science:
- Pediatric Surgery
- Healthcare Quality
- Spinal Fusion Outcomes
Background:
- Retrospective cohort study of 7637 pediatric spinal fusion cases (2004-2006).
- Data sourced from 38 children's hospitals via the Pediatric Health Information System database.
- Evaluated in-hospital outcomes variability by patient factors and facility differences.
Purpose of the Study:
- To assess variability in in-hospital outcomes for pediatric spinal surgery.
- To identify patient and hospital factors associated with adverse outcomes.
- To inform future quality improvement efforts in pediatric spinal surgery.
Main Methods:
- Stratified outcomes based on neurological impairment status (NI vs. NNI).
- Utilized multilevel multivariate logistic regression models.
- Analyzed associations with in-hospital infections, surgical complications, and prolonged length of stay (LOS ≥10 days).
Main Results:
- Neurologically impaired (NI) children (28% of cases) had significantly higher rates of infection (approx. 6x) and complications (approx. 3x).
- Major interhospital variation observed in infection and complication rates, with wide ranges reported across facilities.
- In-hospital infection, surgical complications, and surgical approach (anterior/posterior vs. posterior-only) were associated with LOS ≥10 days; hospital case volume was not.
Conclusions:
- Significant variation in reported outcomes for pediatric spinal surgery exists across US children's hospitals.
- Further research is required to identify hospital-level factors influencing surgical outcomes.
- Findings underscore the need for targeted quality improvement strategies in pediatric spinal surgery.
Background:
We performed a retrospective cohort study of 7637 spinal fusion surgical cases from 2004 to 2006 at 38 children's hospitals participating in the Pediatric Health Information System database to evaluate the variability of in-hospital outcomes by patient factors and between facilities in children who underwent spinal surgery.
Methods:
Outcomes were stratified by whether children did or did not have neurological impairment. Multilevel multivariate logistic regression models were used to determine patient and hospital factors associated with in-hospital infections, surgical complications, and length of stay (LOS)≥10 days.
Results:
Neurologically impaired (NI) children (N=2117 out of 7637) represented 28% of the cases. The interhospital interquartile range of LOS for NI children was 6 to 8 days (median 7 d) and for non-neurologically impaired (NNI) children was 5 to 6 days (median 5 d). Children with NI had roughly 6 times higher rates of in-hospital infection and 3 times higher complication rates: major interhospital variation was seen for both of these outcomes. Hospital rates of infection ranged from 0% to 27% (median 10%) for NI and from 0% to 14% (median 2%) for NNI children. Complication rates ranged from 0% to 89% (median 33%) for NI and from 3% to 68% (median 9%) for NNI children. The following factors were associated with a LOS≥10 days: in-hospital infection (P<0.0001), surgical complication (P<0.0001), and anterior/posterior versus posterior-only surgery (P<0.0001). Hospital case volume was not associated with infection, surgical complication, or LOS≥10 days.
Conclusions:
Substantial variation exists in reported outcomes for children undergoing spinal surgery in children's hospitals within the United States. Further study is needed to characterize hospital-level factors related to surgical outcome to direct future quality improvement.
