Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time
Background: Prior studies have demonstrated an increase in the performance of outpatient anterior cervical surgery. The degree to which this increase is due to volume increase per individual surgeon versus increase in individual surgeons performing outpatient cervical surgery is unknown. Methods: Pa...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-09-01
|
| Series: | North American Spine Society Journal |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266654842200035X |
| _version_ | 1798035970979790848 |
|---|---|
| author | Abhinaba Chatterjee Nada Rbil Michael Yancey Matthew T. Geiselmann Benjamin Pesante Sariah Khormaee |
| author_facet | Abhinaba Chatterjee Nada Rbil Michael Yancey Matthew T. Geiselmann Benjamin Pesante Sariah Khormaee |
| author_sort | Abhinaba Chatterjee |
| collection | DOAJ |
| description | Background: Prior studies have demonstrated an increase in the performance of outpatient anterior cervical surgery. The degree to which this increase is due to volume increase per individual surgeon versus increase in individual surgeons performing outpatient cervical surgery is unknown. Methods: Patients undergoing anterior cervical discectomy and fusion (ACDF) or cervical disk arthroplasty (CDA) between 2010 and 2018 in NY state were identified. As a comparison we also evaluated trends for inpatient ACDF and CDA. Annual outpatient case volumes were calculated and defined as being high (> 20/year), intermediate (>5 and ≤ 20/year) or low (>1 and ≤ 5/year). Descriptive statistics were used to report temporal trends and Poisson regression was used to test for statistical significance. We also analyzed trends in various operative metrics by surgeon volume. Results: In 2010, there were 96 surgeons who performed outpatient ACDF or CDA on a total of 1,855 patients. In 2018, this increased to 253 surgeons performing outpatient ACDF or CDA on a total of 3,372 patients. In comparison, there were 350 surgeons performing 6,783 inpatient cases in 2010 and 376 surgeons performing 6,796 inpatient cases in 2018. The average annual outpatient case volume decreased from 18.8 (95% CI, 13.5 – 24.1) to 12.2 (95% CI, 10.0 – 14.3) surgeries per surgeon. The percentage of surgeons with a high case volume also decreased from 30.2% in 2010 to 10.7% in 2018, whereas the percentage with a low case volume increased (32.3% to 49.8%). Differences between high and low volume surgeons in operative time, length of stay and total charges widened over time. Conclusion: The increase in outpatient anterior cervical surgery appears to be primarily driven by a greater number of surgeons performing ACDF and CDA on an outpatient basis, as opposed to increased case volumes for each surgeon. In contrast, trends for inpatient anterior cervical surgery were stable. |
| first_indexed | 2024-04-11T21:05:59Z |
| format | Article |
| id | doaj.art-82d7631af5d64530859ef8f3f2e0e42b |
| institution | Directory Open Access Journal |
| issn | 2666-5484 |
| language | English |
| last_indexed | 2024-04-11T21:05:59Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | North American Spine Society Journal |
| spelling | doaj.art-82d7631af5d64530859ef8f3f2e0e42b2022-12-22T04:03:21ZengElsevierNorth American Spine Society Journal2666-54842022-09-0111100132Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over timeAbhinaba Chatterjee0Nada Rbil1Michael Yancey2Matthew T. Geiselmann3Benjamin Pesante4Sariah Khormaee5Weill Cornell Medical College, New York, NY, United StatesHospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United StatesHospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United StatesNew York Institute of Technology, College of Osteopathic Medicine, Old Westbury, NY, United StatesThe University of Connecticut School of Medicine, Farmington, CT, United StatesWeill Cornell Medical College, New York, NY, United States; Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States; Corresponding author: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, United States.Background: Prior studies have demonstrated an increase in the performance of outpatient anterior cervical surgery. The degree to which this increase is due to volume increase per individual surgeon versus increase in individual surgeons performing outpatient cervical surgery is unknown. Methods: Patients undergoing anterior cervical discectomy and fusion (ACDF) or cervical disk arthroplasty (CDA) between 2010 and 2018 in NY state were identified. As a comparison we also evaluated trends for inpatient ACDF and CDA. Annual outpatient case volumes were calculated and defined as being high (> 20/year), intermediate (>5 and ≤ 20/year) or low (>1 and ≤ 5/year). Descriptive statistics were used to report temporal trends and Poisson regression was used to test for statistical significance. We also analyzed trends in various operative metrics by surgeon volume. Results: In 2010, there were 96 surgeons who performed outpatient ACDF or CDA on a total of 1,855 patients. In 2018, this increased to 253 surgeons performing outpatient ACDF or CDA on a total of 3,372 patients. In comparison, there were 350 surgeons performing 6,783 inpatient cases in 2010 and 376 surgeons performing 6,796 inpatient cases in 2018. The average annual outpatient case volume decreased from 18.8 (95% CI, 13.5 – 24.1) to 12.2 (95% CI, 10.0 – 14.3) surgeries per surgeon. The percentage of surgeons with a high case volume also decreased from 30.2% in 2010 to 10.7% in 2018, whereas the percentage with a low case volume increased (32.3% to 49.8%). Differences between high and low volume surgeons in operative time, length of stay and total charges widened over time. Conclusion: The increase in outpatient anterior cervical surgery appears to be primarily driven by a greater number of surgeons performing ACDF and CDA on an outpatient basis, as opposed to increased case volumes for each surgeon. In contrast, trends for inpatient anterior cervical surgery were stable.http://www.sciencedirect.com/science/article/pii/S266654842200035XOutpatient spine surgeryACDFCDASurgeon volumeSurgeon characteristicsEpidemiology |
| spellingShingle | Abhinaba Chatterjee Nada Rbil Michael Yancey Matthew T. Geiselmann Benjamin Pesante Sariah Khormaee Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time North American Spine Society Journal Outpatient spine surgery ACDF CDA Surgeon volume Surgeon characteristics Epidemiology |
| title | Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| title_full | Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| title_fullStr | Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| title_full_unstemmed | Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| title_short | Increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| title_sort | increase in surgeons performing outpatient anterior cervical spine surgery leads to a shift in case volumes over time |
| topic | Outpatient spine surgery ACDF CDA Surgeon volume Surgeon characteristics Epidemiology |
| url | http://www.sciencedirect.com/science/article/pii/S266654842200035X |
| work_keys_str_mv | AT abhinabachatterjee increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime AT nadarbil increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime AT michaelyancey increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime AT matthewtgeiselmann increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime AT benjaminpesante increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime AT sariahkhormaee increaseinsurgeonsperformingoutpatientanteriorcervicalspinesurgeryleadstoashiftincasevolumesovertime |