Recently, strategies aimed at optimizing provider factors have been proposed, including regionalization of surgeries to higher volume centers and adoption of volume standards. With limited literature promoting the regionalization of spine surgeries, Malik et al. undertook a systematic review to investigate the impact of surgeon volume on outcomes in patients undergoing spine surgery.
They performed a systematic review examining the association between surgeon volume and spine surgery outcomes. To be included in the review, the study population had to include patients undergoing a primary or revision spinal procedure. These included anterior cervical discectomy and fusion (ACDF), anterior/posterior cervical fusion, laminectomy/decompression, anterior/posterior lumbar decompression with fusion, discectomy, and spinal deformity surgery (spine arthrodesis).
Studies were variable in defining surgeon volume thresholds. Higher surgeon volume was associated with a significantly lower risk of postoperative complications, a lower length of stay (LOS), lower cost of hospital stay and a lower risk of readmissions and reoperations/revisions.
Findings suggest a trend towards better outcomes for higher volume surgeons; however, further study needs to be carried out to define objective volume thresholds for individual spine surgeries for surgeons to use as a marker of proficiency 1).
Patient-rated measures are considered the gold standard for assessing the outcome of spine surgery, but there is no consensus on the appropriate timing of follow-up. Journals often demand a minimum 2-year follow-up, but the indiscriminate application of this principle may not be warranted.
Stable group mean Core Outcome Measures Index scores were observed for all patients from 12 months postoperatively onwards. The early postoperative results appeared to herald the longer term outcome. As such, a 'wait and see policy' in patients with a poor initial outcome at 3 months is not advocated. The insistence on a 2-year follow-up could result in a failure to intervene early to achieve better long-term outcomes. 2).
Variability in the utilization and outcomes of elective spine surgery across different regions in the United States and internationally has become a growing focus of critical evaluation. In 2011, surgeons in Washington State created the Spine Surgical Care and Outcomes Assessment Program to address variability in use, process, and outcome of spine surgery and identified significant variability in the indications, process of care, and outcomes related to spine surgery. This variability indicates the need for continued surveillance initiatives and point to opportunities for quality improvement and research 3).