Impact of neurosurgeon specialization on patient outcomes for intracranial and spinal surgery

A retrospective analysis of the Nationwide Inpatient Sample 1998-2009

Brandon A. McCutcheon, Brian R. Hirshman, Brandon C. Gabel, Michael W. Heffner, Logan P. Marcus, Tyler S. Cole, Clark C. Chen, David C. Chang, Bob S. Carter

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

OBJECTIVE The subspecialization of neurosurgical practice is an ongoing trend in modern neurosurgery. However, it remains unclear whether the degree of surgeon specialization is associated with improved patient outcomes. The authors hypothesized that a trend toward increased neurosurgeon specialization was associated with improved patient morbidity and mortality rates. METHODS The Nationwide Inpatient Sample (NIS) was used (1998-2009). Patients were included in a spinal analysis cohort for instrumented spine surgery involving the cervical spine (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 81.31-81.33, 81.01-81.03, 84.61-84.62, and 84.66) or lumbar spine (codes 81.04-81.08, 81.34-81.38, 84.64-84.65, and 84.68). A cranial analysis cohort consisted of patients receiving a parenchymal excision or lobectomy operation (codes 01.53 and 01.59). Surgeon specialization was measured using unique surgeon identifiers in the NIS and defined as the proportion of a surgeon's total practice dedicated to cranial or spinal cases. RESULTS A total of 46,029 and 231,875 patients were identified in the cranial and spinal analysis cohorts, respectively. On multivariate analysis in the cranial analysis cohort (after controlling for overall surgeon volume, patient demographic data/comorbidities, hospital characteristics, and admitting source), each percentage-point increase in a surgeon's cranial specialization (that is, the proportion of cranial cases) was associated with a 0.0060 reduction in the log odds of patient mortality (95% CI 0.0034-0.0086) and a 0.0042 reduction in the log odds of morbidity (95% CI 0.0032-0.0052). This resulted in a 15% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of cranial specialization. In the spinal analysis cohort, each percentage-point increase in a surgeon's spinal specialization was associated with a 0.0122 reduction in the log odds of mortality (95% CI 0.0074-0.0170) and a 0.0058 reduction in the log odds of morbidity (95% CI 0.0049-0.0067). This resulted in a 26.8% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of spinal specialization. CONCLUSIONS For both spinal and cranial surgery patient cohorts derived from the NIS database, increased surgeon specialization was significantly and independently associated with improved mortality and morbidity rates, even after controlling for overall case volume.

Original languageEnglish (US)
Pages (from-to)1578-1588
Number of pages11
JournalJournal of neurosurgery
Volume128
Issue number5
DOIs
StatePublished - May 1 2018
Externally publishedYes

Fingerprint

Inpatients
Cohort Studies
Mortality
Morbidity
Spine
International Classification of Diseases
Neurosurgeons
Surgeons
Neurosurgery
Comorbidity
Multivariate Analysis
Demography
Databases

Keywords

  • Lobectomy
  • Multivariate analysis
  • NIS
  • Nationwide Inpatient Sample
  • Parenchymal excision
  • Specialization
  • Spinal fusion
  • Surgical outcomes research

PubMed: MeSH publication types

  • Journal Article

Cite this

Impact of neurosurgeon specialization on patient outcomes for intracranial and spinal surgery : A retrospective analysis of the Nationwide Inpatient Sample 1998-2009. / McCutcheon, Brandon A.; Hirshman, Brian R.; Gabel, Brandon C.; Heffner, Michael W.; Marcus, Logan P.; Cole, Tyler S.; Chen, Clark C.; Chang, David C.; Carter, Bob S.

In: Journal of neurosurgery, Vol. 128, No. 5, 01.05.2018, p. 1578-1588.

Research output: Contribution to journalReview article

McCutcheon, Brandon A. ; Hirshman, Brian R. ; Gabel, Brandon C. ; Heffner, Michael W. ; Marcus, Logan P. ; Cole, Tyler S. ; Chen, Clark C. ; Chang, David C. ; Carter, Bob S. / Impact of neurosurgeon specialization on patient outcomes for intracranial and spinal surgery : A retrospective analysis of the Nationwide Inpatient Sample 1998-2009. In: Journal of neurosurgery. 2018 ; Vol. 128, No. 5. pp. 1578-1588.
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title = "Impact of neurosurgeon specialization on patient outcomes for intracranial and spinal surgery: A retrospective analysis of the Nationwide Inpatient Sample 1998-2009",
abstract = "OBJECTIVE The subspecialization of neurosurgical practice is an ongoing trend in modern neurosurgery. However, it remains unclear whether the degree of surgeon specialization is associated with improved patient outcomes. The authors hypothesized that a trend toward increased neurosurgeon specialization was associated with improved patient morbidity and mortality rates. METHODS The Nationwide Inpatient Sample (NIS) was used (1998-2009). Patients were included in a spinal analysis cohort for instrumented spine surgery involving the cervical spine (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 81.31-81.33, 81.01-81.03, 84.61-84.62, and 84.66) or lumbar spine (codes 81.04-81.08, 81.34-81.38, 84.64-84.65, and 84.68). A cranial analysis cohort consisted of patients receiving a parenchymal excision or lobectomy operation (codes 01.53 and 01.59). Surgeon specialization was measured using unique surgeon identifiers in the NIS and defined as the proportion of a surgeon's total practice dedicated to cranial or spinal cases. RESULTS A total of 46,029 and 231,875 patients were identified in the cranial and spinal analysis cohorts, respectively. On multivariate analysis in the cranial analysis cohort (after controlling for overall surgeon volume, patient demographic data/comorbidities, hospital characteristics, and admitting source), each percentage-point increase in a surgeon's cranial specialization (that is, the proportion of cranial cases) was associated with a 0.0060 reduction in the log odds of patient mortality (95{\%} CI 0.0034-0.0086) and a 0.0042 reduction in the log odds of morbidity (95{\%} CI 0.0032-0.0052). This resulted in a 15{\%} difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of cranial specialization. In the spinal analysis cohort, each percentage-point increase in a surgeon's spinal specialization was associated with a 0.0122 reduction in the log odds of mortality (95{\%} CI 0.0074-0.0170) and a 0.0058 reduction in the log odds of morbidity (95{\%} CI 0.0049-0.0067). This resulted in a 26.8{\%} difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of spinal specialization. CONCLUSIONS For both spinal and cranial surgery patient cohorts derived from the NIS database, increased surgeon specialization was significantly and independently associated with improved mortality and morbidity rates, even after controlling for overall case volume.",
keywords = "Lobectomy, Multivariate analysis, NIS, Nationwide Inpatient Sample, Parenchymal excision, Specialization, Spinal fusion, Surgical outcomes research",
author = "McCutcheon, {Brandon A.} and Hirshman, {Brian R.} and Gabel, {Brandon C.} and Heffner, {Michael W.} and Marcus, {Logan P.} and Cole, {Tyler S.} and Chen, {Clark C.} and Chang, {David C.} and Carter, {Bob S.}",
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TY - JOUR

T1 - Impact of neurosurgeon specialization on patient outcomes for intracranial and spinal surgery

T2 - A retrospective analysis of the Nationwide Inpatient Sample 1998-2009

AU - McCutcheon, Brandon A.

AU - Hirshman, Brian R.

AU - Gabel, Brandon C.

AU - Heffner, Michael W.

AU - Marcus, Logan P.

AU - Cole, Tyler S.

AU - Chen, Clark C.

AU - Chang, David C.

AU - Carter, Bob S.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - OBJECTIVE The subspecialization of neurosurgical practice is an ongoing trend in modern neurosurgery. However, it remains unclear whether the degree of surgeon specialization is associated with improved patient outcomes. The authors hypothesized that a trend toward increased neurosurgeon specialization was associated with improved patient morbidity and mortality rates. METHODS The Nationwide Inpatient Sample (NIS) was used (1998-2009). Patients were included in a spinal analysis cohort for instrumented spine surgery involving the cervical spine (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 81.31-81.33, 81.01-81.03, 84.61-84.62, and 84.66) or lumbar spine (codes 81.04-81.08, 81.34-81.38, 84.64-84.65, and 84.68). A cranial analysis cohort consisted of patients receiving a parenchymal excision or lobectomy operation (codes 01.53 and 01.59). Surgeon specialization was measured using unique surgeon identifiers in the NIS and defined as the proportion of a surgeon's total practice dedicated to cranial or spinal cases. RESULTS A total of 46,029 and 231,875 patients were identified in the cranial and spinal analysis cohorts, respectively. On multivariate analysis in the cranial analysis cohort (after controlling for overall surgeon volume, patient demographic data/comorbidities, hospital characteristics, and admitting source), each percentage-point increase in a surgeon's cranial specialization (that is, the proportion of cranial cases) was associated with a 0.0060 reduction in the log odds of patient mortality (95% CI 0.0034-0.0086) and a 0.0042 reduction in the log odds of morbidity (95% CI 0.0032-0.0052). This resulted in a 15% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of cranial specialization. In the spinal analysis cohort, each percentage-point increase in a surgeon's spinal specialization was associated with a 0.0122 reduction in the log odds of mortality (95% CI 0.0074-0.0170) and a 0.0058 reduction in the log odds of morbidity (95% CI 0.0049-0.0067). This resulted in a 26.8% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of spinal specialization. CONCLUSIONS For both spinal and cranial surgery patient cohorts derived from the NIS database, increased surgeon specialization was significantly and independently associated with improved mortality and morbidity rates, even after controlling for overall case volume.

AB - OBJECTIVE The subspecialization of neurosurgical practice is an ongoing trend in modern neurosurgery. However, it remains unclear whether the degree of surgeon specialization is associated with improved patient outcomes. The authors hypothesized that a trend toward increased neurosurgeon specialization was associated with improved patient morbidity and mortality rates. METHODS The Nationwide Inpatient Sample (NIS) was used (1998-2009). Patients were included in a spinal analysis cohort for instrumented spine surgery involving the cervical spine (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 81.31-81.33, 81.01-81.03, 84.61-84.62, and 84.66) or lumbar spine (codes 81.04-81.08, 81.34-81.38, 84.64-84.65, and 84.68). A cranial analysis cohort consisted of patients receiving a parenchymal excision or lobectomy operation (codes 01.53 and 01.59). Surgeon specialization was measured using unique surgeon identifiers in the NIS and defined as the proportion of a surgeon's total practice dedicated to cranial or spinal cases. RESULTS A total of 46,029 and 231,875 patients were identified in the cranial and spinal analysis cohorts, respectively. On multivariate analysis in the cranial analysis cohort (after controlling for overall surgeon volume, patient demographic data/comorbidities, hospital characteristics, and admitting source), each percentage-point increase in a surgeon's cranial specialization (that is, the proportion of cranial cases) was associated with a 0.0060 reduction in the log odds of patient mortality (95% CI 0.0034-0.0086) and a 0.0042 reduction in the log odds of morbidity (95% CI 0.0032-0.0052). This resulted in a 15% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of cranial specialization. In the spinal analysis cohort, each percentage-point increase in a surgeon's spinal specialization was associated with a 0.0122 reduction in the log odds of mortality (95% CI 0.0074-0.0170) and a 0.0058 reduction in the log odds of morbidity (95% CI 0.0049-0.0067). This resulted in a 26.8% difference in the predicted probability of mortality for neurosurgeons at the 75th versus the 25th percentile of spinal specialization. CONCLUSIONS For both spinal and cranial surgery patient cohorts derived from the NIS database, increased surgeon specialization was significantly and independently associated with improved mortality and morbidity rates, even after controlling for overall case volume.

KW - Lobectomy

KW - Multivariate analysis

KW - NIS

KW - Nationwide Inpatient Sample

KW - Parenchymal excision

KW - Specialization

KW - Spinal fusion

KW - Surgical outcomes research

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