Physician-Specific Variability in Spine Fusion Patients

Background It is often assumed that each surgeon's patient population is similar to that of his or her peers. Differences in patient characteristics naturally may lead to diverse outcomes. To date, the variability of individual surgeons' patient populations has not been adequately characterized. The purpose of this study is to describe the variation in physician-specific patient characteristics among surgeons performing spine fusion surgery at a large, urban academic medical center.

Methods We analyzed administrative data from a single institution for spine fusion surgery from 2009 to 2013. There were 6585 primary and 362 revision cases of spine fusion performed within this time period. Variability between surgeons and their respective patient populations was compared using descriptive statistics.

Results The mean annual percentage of primary fusion patients with diabetes mellitus ranged from 0 to 16.17% (mean ± SD, 7.79% ± 3.96%) but constituted anywhere from 0 to 41.58% (mean ± SD, 8.15% ± 12.09%) of revision fusions. The mean annual percentage of primary fusion patients who were obese ranged from 0 to 9% (mean ± SD, 2.95% ± 2.7%), and 0 to 25% in revision cases (mean ± SD, 3.43% ± 6.43%). The annual mean percentage of patients with American Society of Anesthesiologists (ASA) scores greater than 3 ranged from 8.8% to 44.43% (mean ± SD, 20.42% ± 8.85%) in primary fusions and 0 to 100% (mean ± SD, 32.79% ± 23.47%) in revision fusions.

Conclusion There was a large amount of variability among surgeons' patient populations when looking at characteristics such as obesity, diabetes, and ASA scores >3. These factors have been shown to impact patient outcomes. The variability in the patient populations of individual surgeons' practices even within the same medical center must be taken into account when evaluating physician specific outcomes and quality of care.