Physician-Specific Variability in Spine Fusion Patients

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Surgical Outcomes

Background:

• Surgeon patient populations are often assumed to be similar.
• Patient characteristic differences can influence surgical outcomes.
• Variability in individual surgeon patient populations has not been well-characterized.

Purpose of the Study:

• To describe physician-specific patient characteristic variations among spine fusion surgeons.
• To analyze patient population differences at a large, urban academic medical center.

Main Methods:

• Analysis of administrative data for spine fusion surgery (2009-2013).
• Inclusion of 6585 primary and 362 revision cases.
• Comparison of surgeon and patient population variability using descriptive statistics.

Main Results:

• Significant variability observed in the prevalence of diabetes, obesity, and American Society of Anesthesiologists (ASA) scores >3 among surgeons' patient populations for both primary and revision spine fusions.
• For primary fusions, mean annual diabetes prevalence ranged from 0-16.17%, obesity from 0-9%, and ASA scores >3 from 8.8%-44.43%.
• Revision fusions showed even greater variability, with diabetes prevalence ranging from 0-41.58%, obesity from 0-25%, and ASA scores >3 from 0-100%.

Conclusions:

• Substantial variability exists in surgeon-specific patient populations regarding key health characteristics.
• These patient factors (obesity, diabetes, ASA score) are known to affect surgical outcomes.
• Accounting for patient population variability is crucial for accurate evaluation of surgeon-specific outcomes and quality of care in spine fusion surgery.