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

Introduction  Many clinical, social, and even economic factors have been extensively analyzed in the literature and shown to influence the length of stay (LOS) after spinal procedures. However, surgeon’s experience was mostly examined relative to a learning curve and not regarding the time in practi...

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Autores principales: Rajpal, Sharad, Shah, Mancy, Vivek, Niketna, Burneikiene, Sigita
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522170/
https://www.ncbi.nlm.nih.gov/pubmed/33005520
http://dx.doi.org/10.7759/cureus.10099
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author Rajpal, Sharad
Shah, Mancy
Vivek, Niketna
Burneikiene, Sigita
author_facet Rajpal, Sharad
Shah, Mancy
Vivek, Niketna
Burneikiene, Sigita
author_sort Rajpal, Sharad
collection PubMed
description Introduction  Many clinical, social, and even economic factors have been extensively analyzed in the literature and shown to influence the length of stay (LOS) after spinal procedures. However, surgeon’s experience was mostly examined relative to a learning curve and not regarding the time in practice. The primary objective of this study was to determine the effect of one surgeon’s experience on the LOS in patients undergoing one- to two-level transforaminal lumbar interbody fusions (TLIFs). Materials and Methods  The study design was a retrospective cohort study of hospital discharge data. The cohort was comprised of 240 consecutive patients who had undergone open one- or two-level elective TLIF procedures for lumbar degenerative disc disease. The primary predictor was the surgeon’s experience based upon the years of practice. The primary outcome was LOS, which was controlled by the discharge criteria that remained consistent throughout the study. Results  Based on the Poisson regression model, it can be inferred that the LOS is not significantly associated with a surgeon’s experience (Pr(>|t|) = 0.8985, CI: -0.5825 to 0.5114) while controlling for all other variables. Other independent factors did seem to significantly influence patients’ LOS, including the admission type (Pr(>|t|) = 9.637(-08), CI: -0.8186 to -0.3786), the number of TLIF levels (Pr(>|t|) = 1.721(-06), CI: 0.0606 to 0.1446), the Clavien-Dindo ( Pr(>|t|) = 0, CI: 0.1489 to 0.1494), the American Society of Anesthesiologists (ASA) physical status classification scores (Pr(>|t|) = 4.878(-3), CI: 0.0336 to 0.1880), and being discharged to skilled nursing facility (Pr(>|t|) = 3.44(-2), CI: 0.0127 to 0.3339). Conclusions Based upon the years in practice, surgeon experience was not associated with length of hospitalization and estimated blood loss during surgery in patients undergoing one- and two-level TLIF surgeries. However, while controlling for all other variables, the surgeon’s experience and surgical time had a highly significant correlation. The study results clearly demonstrated efficiency, but we did not identify a clear correlation between LOS and surgeon experience overtime suggesting that other factors are likely contributing to such outcome. The average LOS is a complex measure of healthcare resource use and hospital discharge policy or other variables are likely having more effect on LOS than individual surgeons’ preferences.
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spelling pubmed-75221702020-09-30 Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay Rajpal, Sharad Shah, Mancy Vivek, Niketna Burneikiene, Sigita Cureus Neurosurgery Introduction  Many clinical, social, and even economic factors have been extensively analyzed in the literature and shown to influence the length of stay (LOS) after spinal procedures. However, surgeon’s experience was mostly examined relative to a learning curve and not regarding the time in practice. The primary objective of this study was to determine the effect of one surgeon’s experience on the LOS in patients undergoing one- to two-level transforaminal lumbar interbody fusions (TLIFs). Materials and Methods  The study design was a retrospective cohort study of hospital discharge data. The cohort was comprised of 240 consecutive patients who had undergone open one- or two-level elective TLIF procedures for lumbar degenerative disc disease. The primary predictor was the surgeon’s experience based upon the years of practice. The primary outcome was LOS, which was controlled by the discharge criteria that remained consistent throughout the study. Results  Based on the Poisson regression model, it can be inferred that the LOS is not significantly associated with a surgeon’s experience (Pr(>|t|) = 0.8985, CI: -0.5825 to 0.5114) while controlling for all other variables. Other independent factors did seem to significantly influence patients’ LOS, including the admission type (Pr(>|t|) = 9.637(-08), CI: -0.8186 to -0.3786), the number of TLIF levels (Pr(>|t|) = 1.721(-06), CI: 0.0606 to 0.1446), the Clavien-Dindo ( Pr(>|t|) = 0, CI: 0.1489 to 0.1494), the American Society of Anesthesiologists (ASA) physical status classification scores (Pr(>|t|) = 4.878(-3), CI: 0.0336 to 0.1880), and being discharged to skilled nursing facility (Pr(>|t|) = 3.44(-2), CI: 0.0127 to 0.3339). Conclusions Based upon the years in practice, surgeon experience was not associated with length of hospitalization and estimated blood loss during surgery in patients undergoing one- and two-level TLIF surgeries. However, while controlling for all other variables, the surgeon’s experience and surgical time had a highly significant correlation. The study results clearly demonstrated efficiency, but we did not identify a clear correlation between LOS and surgeon experience overtime suggesting that other factors are likely contributing to such outcome. The average LOS is a complex measure of healthcare resource use and hospital discharge policy or other variables are likely having more effect on LOS than individual surgeons’ preferences. Cureus 2020-08-28 /pmc/articles/PMC7522170/ /pubmed/33005520 http://dx.doi.org/10.7759/cureus.10099 Text en Copyright © 2020, Rajpal et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Neurosurgery
Rajpal, Sharad
Shah, Mancy
Vivek, Niketna
Burneikiene, Sigita
Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title_full Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title_fullStr Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title_full_unstemmed Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title_short Analyzing the Correlation Between Surgeon Experience and Patient Length of Hospital Stay
title_sort analyzing the correlation between surgeon experience and patient length of hospital stay
topic Neurosurgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522170/
https://www.ncbi.nlm.nih.gov/pubmed/33005520
http://dx.doi.org/10.7759/cureus.10099
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