Effect of Surgeon Volume on Complications, Length of Stay, and Costs Following Anterior Cervical Fusion

Study Design. Retrospective cohort. Objective. To identify the association between surgeon volume and inpatient complications, length of stay, and costs associated with ACF. Summary of Background Data. Increased surgeon volume may be associated with improved outcomes after surgical procedures. However, there is a lack of information on the effect of surgeon volume on short-term outcomes after anterior cervical fusion (ACF). Methods. A retrospective cohort study of ACF patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Surgeon volume was divided into three categories, volume < 25th percentile, 25th to 74th percentile, and > 75th percentile of surgeon volume. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital costs between surgeon volume categories. Results. A total of 419,212 ACF patients were identified. The 25th percentile for volume was 5 cases per year, and the 75th percentile for volume was 67 cases per year. Volume < 25th percentile was associated with increased rates of any adverse event (odd ratio, OR 3.8, P< 0.001), and multiple individual complications including death (OR 2.5, P = 0.014), myocardial infarction (OR4.4, P< 0.001), sepsis (OR 4.1, P< 0.001), and surgical site infection (OR 4.0, P< 0.001). Notably, volume >= 75th percentile was associated with decreased rates of any adverse event (OR 0.7, P < 0.001) and death (OR 0.6, P = 0.028). On multivariate analysis, length of stay was significantly increased by 2.3 days (P< 0.001) for surgeons < 25th percentile of volume and was decreased by 0.3 days for surgeons with volume >= 75th percentile. Hospital costs were $ 4569 more for surgeons with < 25th percentile of volume and $ 1213 less for surgeons with >= 75th percentile volume. Conclusion. In this nationally representative sample, surgeons with volume < 25th percentile had significantly increased complications, length of stay, and costs. Conversely, surgeons with >= 75th percentile volume experienced decreased complications, length of stay, and costs.