Evidence-Based Thresholds for the Volume-Value Relationship in Adolescent Idiopathic Scoliosis: Outcomes and Economies of Scale
| Autor: | Sergio M. Navarro, Prem N. Ramkumar, Anthony C. Egger, Ryan C. Goodwin |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Evidence-based practice Adolescent Cost effectiveness medicine.medical_treatment Idiopathic scoliosis 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine Humans Orthopedics and Sports Medicine Child Surgeons 030222 orthopedics Receiver operating characteristic business.industry Infant Newborn Infant Length of Stay Hospitals Economies of scale Spinal Fusion Treatment Outcome Scoliosis Child Preschool Evidence-Based Practice Spinal fusion Emergency medicine Orthopedic surgery Female business 030217 neurology & neurosurgery Volume (compression) |
| Zdroj: | Spine Deformity. 6:156-163 |
| ISSN: | 2212-134X |
| Popis: | Increased surgeon and hospital volume has been associated with improved patient outcomes and cost effectiveness for adolescent idiopathic scoliosis (AIS). However, no evidence-based thresholds that clarify the volume at which these strata occur exist. The objective of this study was to establish statistically meaningful thresholds that define high-volume surgeons and hospitals performing spinal fusion for AIS from those that are low volume with respect to length of stay (LOS) and cost.Using 3,224 patients undergoing spinal fusion for AIS from an administrative database, we created and applied four models using stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve. We generated four sets of thresholds predictive of adverse outcomes, namely, increased cost and LOS, for both surgeon and hospital volume.For both LOS and cost, surgeon volume produced the same strata with low volume identified as 0-5 annual surgeries and high as greater than 5. LOS and cost decreased significantly (p.05) between volume strata. For hospital volume in terms of LOS, low volume was identified as 0-10 annual surgeries and high as greater than 10; in terms of cost, low volume was identified as 0-15 annual surgeries and high as greater than 15. LOS decreased significantly (p.05) and cost was $1,500 less but not statistically significant between volume strata for hospital volume.Our study of risk-based volume stratification established a direct volume-value relationship for surgeons and hospitals performing fusion for AIS. A meaningful threshold for low- and high-volume surgeons was established at 5 annual surgeries, but no consensus or clinically meaningful conclusion was reached for hospitals, although the threshold approached 10-15 annual surgeries. This analysis should aid patients, surgeons, and administration reach value-based decisions in the optimal delivery of pediatric spinal fusion for AIS. |
| Databáze: | OpenAIRE |
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