Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds
Objective Increased surgical volume has been associated with improved patient outcomes at the surgeon and hospital level. To date, clinically meaningful stratified volume benchmarks have yet to be defined for surgeons or hospitals in the context of spinal fusion surgery. The objective of this study...
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| Format: | Article |
| Language: | English |
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Korean Spinal Neurosurgery Society
2018-09-01
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| Series: | Neurospine |
| Subjects: | |
| Online Access: | http://www.e-neurospine.org/upload/pdf/ns-1836088-044.pdf |
| _version_ | 1797333469116760064 |
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| author | Sergio M. Navarro William Case Frankel Heather S. Haeberle Prem N. Ramkumar |
| author_facet | Sergio M. Navarro William Case Frankel Heather S. Haeberle Prem N. Ramkumar |
| author_sort | Sergio M. Navarro |
| collection | DOAJ |
| description | Objective Increased surgical volume has been associated with improved patient outcomes at the surgeon and hospital level. To date, clinically meaningful stratified volume benchmarks have yet to be defined for surgeons or hospitals in the context of spinal fusion surgery. The objective of this study was to establish evidence-based thresholds using outcomes and cost to stratify surgeons and hospitals performing spinal fusion surgery by volume. Methods Using 155,788 patients undergoing spinal fusion surgery, we created and applied 4 models using stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve. This statistical approach was used to generate 4 sets of volume thresholds predictive of increased length of stay (LOS) and increased cost for surgeons and hospitals. Results SSLR analysis of the 2 ROC curves by annual surgical volume produced 3 or 4 distinct volume categories. Analysis of LOS by annual surgeon spinal fusion volume produced 4 strata: low, medium, high, and very high. Analysis of LOS by annual hospital spinal fusion volume produced 3 strata: low, medium, and high. No relationship between volume and cost could be clearly defined based on the generation of ROC curves for surgeons or hospitals offering spinal fusion. Conclusion This study used evidence-based thresholds to identify a direct, variable relationship model between volume and outcomes of spinal fusion surgery, using LOS as a surrogate, for both surgeons and hospitals. A fixed relationship model was identified between surgeon and hospital volume and cost, as no statistically meaningful relationship could be established. |
| first_indexed | 2024-03-08T08:04:18Z |
| format | Article |
| id | doaj.art-1d2b7fb79b1c4bc48bf7503860021b82 |
| institution | Directory Open Access Journal |
| issn | 2586-6583 2586-6591 |
| language | English |
| last_indexed | 2024-03-08T08:04:18Z |
| publishDate | 2018-09-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj.art-1d2b7fb79b1c4bc48bf7503860021b822024-02-02T11:12:23ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912018-09-0115324926010.14245/ns.1836088.044815Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based ThresholdsSergio M. Navarro0William Case Frankel1Heather S. Haeberle2Prem N. Ramkumar3 Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA Cleveland Clinic Foundation, Cleveland, OH, USAObjective Increased surgical volume has been associated with improved patient outcomes at the surgeon and hospital level. To date, clinically meaningful stratified volume benchmarks have yet to be defined for surgeons or hospitals in the context of spinal fusion surgery. The objective of this study was to establish evidence-based thresholds using outcomes and cost to stratify surgeons and hospitals performing spinal fusion surgery by volume. Methods Using 155,788 patients undergoing spinal fusion surgery, we created and applied 4 models using stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve. This statistical approach was used to generate 4 sets of volume thresholds predictive of increased length of stay (LOS) and increased cost for surgeons and hospitals. Results SSLR analysis of the 2 ROC curves by annual surgical volume produced 3 or 4 distinct volume categories. Analysis of LOS by annual surgeon spinal fusion volume produced 4 strata: low, medium, high, and very high. Analysis of LOS by annual hospital spinal fusion volume produced 3 strata: low, medium, and high. No relationship between volume and cost could be clearly defined based on the generation of ROC curves for surgeons or hospitals offering spinal fusion. Conclusion This study used evidence-based thresholds to identify a direct, variable relationship model between volume and outcomes of spinal fusion surgery, using LOS as a surrogate, for both surgeons and hospitals. A fixed relationship model was identified between surgeon and hospital volume and cost, as no statistically meaningful relationship could be established.http://www.e-neurospine.org/upload/pdf/ns-1836088-044.pdfSpinal fusionValue-volumeStratum-specific likelihood ratio |
| spellingShingle | Sergio M. Navarro William Case Frankel Heather S. Haeberle Prem N. Ramkumar Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds Neurospine Spinal fusion Value-volume Stratum-specific likelihood ratio |
| title | Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds |
| title_full | Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds |
| title_fullStr | Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds |
| title_full_unstemmed | Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds |
| title_short | Fixed and Variable Relationship Models to Define the Volume-Value Relationship in Spinal Fusion Surgery: A Macroeconomic Analysis Using Evidence-Based Thresholds |
| title_sort | fixed and variable relationship models to define the volume value relationship in spinal fusion surgery a macroeconomic analysis using evidence based thresholds |
| topic | Spinal fusion Value-volume Stratum-specific likelihood ratio |
| url | http://www.e-neurospine.org/upload/pdf/ns-1836088-044.pdf |
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