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Geographic Variation in the Surgical Treatment of Degenerative Cervical Disc Disease: American Board of Orthopedic Surgery (ABOS) Quality Improvement Initiative; Part II Candidates

Variación geográfica en el tratamiento quirúrgico de la enfermedad discal degenerativa cervical: Iniciativa de la Junta Americana de Cirugía Ortopédica (ABOS) Mejoramiento de la Calidad; Parte II Los candidatos


Este artículo es originalmente publicado en:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490631/

Spine (Phila Pa 1976). Author manuscript; available in PMC Jan 1, 2013.
Published in final edited form as:
PMCID: PMC3490631
NIHMSID: NIHMS276843

Geographic Variation in the Surgical Treatment of Degenerative Cervical Disc Disease: American Board of Orthopedic Surgery (ABOS) Quality Improvement Initiative; Part II Candidates

Kevin J. McGuire, MD, MS,1 John Harrast, MS,2 Harry Herkowitz, MD,3 and James N. Weinstein, DO, MS4
The publisher’s final edited version of this article is available at Spine (Phila Pa 1976)
See other articles in PMC that cite the published article.

Abstract

Study Design

Retrospective case series

Objective

To examine and document the change in rates and the geographic variation in procedure type and utilization of plating by orthopaedic surgeons for anterior cervical discectomy–fusion (ACDF).

Summary of Background

Age- and gender-adjusted rates of cervical spine surgery have not increased but the rate of cervical spinal fusion has, accounting for 41% of all fusion procedures in 2004.

Methods

Records were selected from the American Board of Orthopaedic Surgeons Part II examination from 1999–2008. CPT and ICD-9-CM codes were used to determine utilization of structural allograft, autograft/interbody devices, and anterior cervical plating over time and within geographic region. Main outcome measures were physician workforce, and rates and variation of procedure types.

Results

From 1999 to 2008, the number of self-declared orthopaedic spine surgeon candidates increased 24%. Over this period, the annual number of discectomies with fusions for degenerative cervical disc disease increased by 67%, while the number of such operations per surgeon operating on at least one such case increased 48% (p=0.018). Interbody device (0% to 31%; p<0.0001), anterior cervical plating (39% to 79%; p<0.0001), and allograft (14% to 59%; p<0.0001) use increased, while autograft use decreased (86% to 10%; p<0.0001).
The Southwest and Southeast were more likely than the Midwest to use interbody devices (OR 2.42 and 1.66 respectively). The Southwest and Northeast were more likely than the Midwest to use autograft (OR 1.55 and 1.49). The Southwest, Northeast, and Southeast were less likely to use allograft than the Midwest (OR 0.408, 0.742, and 0.770). The Northeast was less likely and the Southeast more likely than the Midwest to utilize anterior cervical plating (OR 0.67 and 1.33). Surgical complications were more often associated with autograft compared to allograft (OR 1.61).

Conclusions

From 1999–2008, the number of orthopaedic surgeon candidates performing spine surgery has increased. These surgeons are performing more fusions, and utilizing more structural allografts, interbody devices and/or anterior cervical plates. Regional variations also remain in the type of constructs utilized.

Abstract

Study Design

Retrospective case series

Objective

To examine and document the change in rates and the geographic variation in procedure type and utilization of plating by orthopaedic surgeons for anterior cervical discectomy–fusion (ACDF).

Summary of Background

Age- and gender-adjusted rates of cervical spine surgery have not increased but the rate of cervical spinal fusion has, accounting for 41% of all fusion procedures in 2004.

Methods

Records were selected from the American Board of Orthopaedic Surgeons Part II examination from 1999–2008. CPT and ICD-9-CM codes were used to determine utilization of structural allograft, autograft/interbody devices, and anterior cervical plating over time and within geographic region. Main outcome measures were physician workforce, and rates and variation of procedure types.

Results

From 1999 to 2008, the number of self-declared orthopaedic spine surgeon candidates increased 24%. Over this period, the annual number of discectomies with fusions for degenerative cervical disc disease increased by 67%, while the number of such operations per surgeon operating on at least one such case increased 48% (p=0.018). Interbody device (0% to 31%; p<0.0001), anterior cervical plating (39% to 79%; p<0.0001), and allograft (14% to 59%; p<0.0001) use increased, while autograft use decreased (86% to 10%; p<0.0001).
The Southwest and Southeast were more likely than the Midwest to use interbody devices (OR 2.42 and 1.66 respectively). The Southwest and Northeast were more likely than the Midwest to use autograft (OR 1.55 and 1.49). The Southwest, Northeast, and Southeast were less likely to use allograft than the Midwest (OR 0.408, 0.742, and 0.770). The Northeast was less likely and the Southeast more likely than the Midwest to utilize anterior cervical plating (OR 0.67 and 1.33). Surgical complications were more often associated with autograft compared to allograft (OR 1.61).

Conclusions

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