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The impact of surgeon volume on patient outcome in spine surgery: a systematic review

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Abstract

Purpose

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, we undertook a systematic review to investigate the impact of surgeon volume on outcomes in patients undergoing spine surgery.

Methods

We 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).

Results

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.

Conclusions

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.

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Funding

No funding was required for this study.

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Authors and Affiliations

  1. Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Azeem Tariq Malik

  2. Section of Orthopaedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan

    Usman Younis Panni, Maryam Tetlay & Shahryar Noordin

  3. Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC, USA

    Muhammad Usman Mirza

Authors
  1. Azeem Tariq Malik
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  2. Usman Younis Panni
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  3. Muhammad Usman Mirza
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  4. Maryam Tetlay
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  5. Shahryar Noordin
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Corresponding author

Correspondence to Azeem Tariq Malik.

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No conflict of interest was declared by the authors.

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Malik, A.T., Panni, U.Y., Mirza, M.U. et al. The impact of surgeon volume on patient outcome in spine surgery: a systematic review. Eur Spine J 27, 530–542 (2018). https://doi.org/10.1007/s00586-017-5447-2

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  • DOI: https://doi.org/10.1007/s00586-017-5447-2

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