Measuring the Quality of Care for Spine Surgery

Cedars-Sinai is committed to the latest spine expertise, treatment and research. As a result, the Cedars-Sinai Spine Center has developed into a comprehensive and advanced spine center dedicated to the evaluation, diagnosis and treatment of all neck, back pain and spinal conditions. 

The Cedars-Sinai Spine Center has a multidisciplinary team of surgeons, surgical fellows, specialized spine nurses, and conservative care and diagnostic specialists.

Research and teaching are emphasized by the center that help us to provide the most state-of-the-art clinical care available. Numerous clinical trials are being conducted and developed to pursue the latest techniques available to create the most effective treatments to alleviate back and neck pain.

The center is currently conducting clinical trials in artificial disc replacement to treat pain and disability caused by cervical and lumbar disc disease. Other current studies include nonfusion devices for spinal stabilization, bone morphogenetic protein applications for enhancing the success of spinal fusion, Facet joint replacement and laboratory research involving biomechanics and biotechnology for spinal regeneration.

Our goal is to ensure that all patients are cared for with respect and efficiency through their course of treatment for their spinal disorders.

Surgeons affiliated with the Spine Center performed almost 95 percent of the 2000+ spine procedures done at Cedars-Sinai. This total includes hundreds spinal fusions.

MS-DRGs are patient groupings defined by the Center for Medicare and Medicaid Services, based on patient diagnoses, procedures, gender, age, and discharge status. Information for the three highest volume MS-DRGs are listed in the tables below.

Number of Patients Treated

Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e., lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways.

In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel.

Commitment to quality standards throughout the institution is also an important determinant of better outcomes. (Footnotes 1,2)  In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly trained surgeons than by general surgeons. (Footnote 3)

Procedure Name (MS-DRG)

High Volume Spine Procedures Performed at Cedars-Sinai in 2016

MS-DRG 460 spinal fusion except cervical w/o major complications and comorbidities (cc/mcc) - includes: lumbar fusions and lumbar refusions; all approaches

 462

MS-DRG 520 back and neck procedures except spinal fusion w/o mcc/cc

231

MS-DRG 473 cervical spinal fusion w/o cc/mcc (includes: cervical fusions and cervical refusions; all approaches)

223


Patient Care Processes and Outcomes

As part our effort to provide the highest quality of care, Cedars-Sinai routinely monitors indicators reflecting quality of care. Patient outcomes are also compared to the outcomes expected for a clinical similar patient population, when this comparative data is available. These measures include:

Average Length of Stay

Procedure Name (MS-DRG)

Cedars-Sinai 2016

*Expected

MS-DRG 460 spinal fusion except cervical w/o mcc (includes: lumbar fusions and lumbar refusions; all approaches)

3.7 days

3.0 days

MS-DRG 520 back and neck procedures except spinal fusion w/o mcc/cc

1.9 days

1.3 days

MS-DRG 473 cervical spinal fusion w/o cc/mcc (includes: cervical fusions and cervical refusions; all approaches)

1.9 days

1.1 days

 

Percent Mortality

Procedure Name (MS-DRG)

Cedars-Sinai 2016

*Expected

MS-DRG 460 spinal fusion except cervical w/o mcc (includes: lumbar fusions and lumbar refusions; all approaches)

0

0.16%

MS-DRG 520 back and neck procedures except spinal fusion w/o mcc/cc

0

0.11%

MS-DRG 473 cervical spinal fusion w/o cc/mcc (includes: cervical fusions and cervical refusions; all approaches)

0

0.08%

 

Percent ICU Cases and Percent Unplanned 30 Day Readmissions

 Procedure Name (MS-DRG)

Percent of Unplanned  Transfers to ICU 2016, All Physicians

Percent of Unplanned Readmissions within 30 Days of Discharge 2016, All Physicians

MS-DRG 460 spinal fusion except cervical w/o mcc (includes: lumbar fusions and lumbar refusions; all approaches)

2.8%

3.7%

MS-DRG 520 back and neck procedures except spinal fusion w/o mcc/cc

0.0%

3.5%

MS-DRG 473 cervical spinal fusion w/o cc/mcc (includes: cervical fusions and cervical refusions; all approaches)

0.9%

1.8%

 

*The data comes from the University HealthSystem Consortium (UHC), an alliance of more than 300 of the nation’s non-profit academic medical centers and their affiliated hospitals. The majority of these facilities participate in UHC's Clinical DataBase/Resource Manager.  The data were accessed on Feb. 25, 2017, for patients discharged during 2016.

*Expected length of stay and mortality are calculated by UHC, based on patients with similar clinical characteristics. 


Functional Improvement 

Patient reported progress  at 3, 6, 12 and 24 month post-surgery is also measured.  The Oswestry Disability Index (ODI) is one of the principal condition-specific outcome measures used in the management of spinal disorders.

The ODI is the most commonly utilized tool for outcome measure in patients with low back pain  It has been extensively tested, shown good psychometric properties, and is applicable in a wide variety of settings.

The ODI gives a subjective percentage score for level of function (disability) in activities of daily living for those individuals rehabilitating from low back pain. Results from patients surveys are presented below. 

Pain Assessment 

The Cedars-Sinai Spine Center also measures a patient’s level of pain at three, six, 12 and 24 months post-surgery. This survey asks patients to rate their pain along a continuum from "no pain" to "worst possible pain". Scores were compared over time to assess the level of improvement. The results are presented below.

 


[1] Bach PB, Ann Intern Med 2009; 150:729-30
[2] Greene FL, Ann Surg Oncol 2007; 15:14-15
[3] Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08