Volume-Outcome Relationship After 1 and 2 Level Anterior Cervical Discectomy and Fusion

Relationship between surgeon volume and outcomes in spine surgery: a dose-response meta-analysis

“…Considering that hospital volume, teaching status and operative complexity index may largely introduce bias, we also performed subgroup analyses based on whether these confounders were adjusted or not. Two studies involving anterior cervical fusion were from the Nationwide Inpatient Sample database and it was difficult to judge whether the study by De la Garza Ramos et al was included in the study by Basques and colleagues (20,22). Accordingly, we conducted sensitivity analysis through removing the study by De la Garza Ramos and colleagues, which may introduce potential bias in the current metaanalysis.…”

“…Of these, eleven conformed to the inclusion criteria and none of the additional studies were eligible after carefully checking the references of included studies and important reviews. Finally, eleven studies were included in the current meta-analysis (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”

“…The data of 7 studies were from the Nationwide Inpatient Sample Database (20,(22)(23)(24)(25)(26)(27) three from Florida Statewide Inpatient Database (28-30) and one from MarketScan Longitudinal Database (21). Three studies involved lumbar spine surgery (26)(27)(28), four involved cervical spine surgery (20)(21)(22)30), and the others involved spinal deformity surgery or tumor surgery (23)(24)(25)29). All the included studies involved adult spine surgery, except the study by Paul and colleagues (24).…”

“…Also, there is a potential trend of regionalization in spine surgery, but whether a similar volume-outcomes relationship also existed is unknown and an accumulation of high-grade evidence is lacking (19). Additionally, some studies published recently reported conflicting results (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Two studies suggested that higher volume surgeons were associated with increased postoperative mortality in patients undergoing lumbar spine surgery and anterior cervical fusion (22,27).…”

Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay

“…The acquisition and development of skills are critical components of any surgeon's training, but the volume of cases and years in practice are the two main factors that determine surgical performance outcomes [1,2]. It has been demonstrated that increased surgical volume was associated with lower readmission rates [3] and perioperative complications [3,4] in patients undergoing spinal surgeries. Surgeon's experience has also been linked to surgery duration and blood loss [5,6], the accuracy of pedicle screw placement [7], and clinical outcomes [6].…”