Richard Krasner: Spinal Fusion Outcomes in Washington State

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One of the most common procedures in workers’ compensation is lumbar fusion, according to Joe Paduda, the source of today’s blog post subject. In his blog post entitled, What We Nerds Love…, Joe discusses a study recently released on back surgery outcomes in the State of Washington in the February edition of Health Services Research.The study on the safety of lumbar fusions, Joe reports, found that outcomes — defined as complications within 90 days of a fusion – for workers’ comp patients were not nearly as bad as he thought they would be, but he found that they were somewhat better than the average. Joe believes that this may be due in part to the Washington State’s IndustrialInsurance Fund’s tough stance on authorizing fusions.  In turn, that was based on prior research that indicated fusions had generally poor outcomes.  He believes that their numbers may have been better because they do a good job of winnowing out those claimants more likely to have poor outcomes. In going to the abstract of the study, I found the following statistics from the report in the principal findings: Complications within 90 days of a fusion occurred in 4.8 percent of patients, and 2.2 percent had a reoperation. Hospital effects accounted for 8.8 percent of the total variability, and surgeon effects account for 14.4 percent. Surgeon factors account for 54.5 percent of the variation in hospital reoperation rates, and 47.2 percent of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of bone morphogenetic proteins, accounted for 30 and 50 percent of the variation in surgeons’ reoperation and complication rates, respectively. Their conclusion stated that quality improvement efforts that focus on surgeons’ discretionary use of operative techniques may be more effective than those that target hospitals, in order to improve the safety of lumbar spinal fusion surgery. In my White Paper on the legal barriers to implementing medical tourism into workers’ compensation provider networks (pg. 15-16), I mention that Washington State is one of two US states where workers’ comp laws allow claimants to seek medical treatment in other countries, and that the Washington State work comp agency has a page on its website that lists the countries it has accepted as destinations for medical care. The names of the providers are found on PDF files under each country name. It would be interesting to find out what the outcomes for lumbar spinal fusion surgery are in the hospitals I listed in my recent post, No Back Alleys Here: Medical Tourism Hospitals, Clinics and Networks in Latin American and the Caribbean, especially in the Cayman Spine Institute, which has spinal surgeons from the US on staff. If Joe is right about Washington State being better than average, we have to ask what is the average, and how does that compare to hospitals closer to the US in the Western hemisphere? If anyone has such numbers, I’d love to see it, and would welcome you to collaborate on this blog with that information.  

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