Optimizing the Volume–Value Relationship in Laminectomy: An Evidence-Based Analysis of Outcomes and Economies of Scale

The objective of the present study was to establish evidence-based volume thresholds for surgeons and hospitals predictive of enhanced value in the setting of laminectomy. Summary of Background Data. Previous studies have attempted to characterize the relationship between volume and value; however, none to the authors’ knowledge has employed an evidence-based approach to identify thresholds yielding enhanced value. Methods. In total, 67,758 patients from the New York Statewide Planning and Research Cooperative System database undergoing laminectomy in the period 2009 to 2015 were included. We used stratum-specific likelihood ratio analysis of receiver operating characteristic curves to establish volume thresholds predictive of increased length of stay (LOS) and cost for surgeons and hospitals. Results. Analysis of LOS by surgeon volume produced strata at: 71 (very high). Analysis of cost by surgeon volume produced strata at: 86 (very high). Analysis of LOS by hospital volume produced strata at: 172 (very high). Analysis of cost by hospital volume produced strata at: 169 (very high). LOS and cost decreased significantly (P 
Source: Spine - Category: Orthopaedics Tags: OUTCOMES Source Type: research