205. The association of U.S. News & World Report hospital ranking and outcomes following anterior cervical fusions: an analysis of Medicare beneficiaries

Abstract

BACKGROUND CONTEXT The U.S. News and World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying top hospitals for each specialty. While these rankings are advertised by the media widely, and are routinely used by consumers (ie, patients) as a guide in seeking care for their ailments, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited. PURPOSE The current study aims to evaluate whether there are any differences in outcomes and costs for patients undergoing elective 1-to-3 level anterior cervical fusions at ranked and unranked hospitals. STUDY DESIGN/SETTING Retrospective review of 2010-2014 100% Medicare claims PATIENT SAMPLE The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in “neurosurgery” and “orthopedics.” Because surgeons from both specialties routinely perform elective lumbar fusions, top ranked hospitals from both specialties were included in the study. The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective 1-to-3 level anterior cervical fusions for degenerative spinal pathology. The study cohort was divided into two groups, 1) patients who received surgery at a ranked hospital vs 2) patients who received surgery at a unranked hospital. OUTCOME MEASURES Ninety-day complications, charges and costs. METHODS Multivariate logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and non-ranked hospitals, while controlling for age, gender, region, co-morbidity burden, socioeconomic status, hospital bed size, teaching status, location, facility ownership model and hospital volume. RESULTS A total of 110,520 patients undergoing elective 1-to-3 level anterior cervical fusions were included in the study, out of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals across the study time period. Ranked hospitals were more likely to have a higher annual case volume, be located in an urban location, have greater bed size, be teaching hospitals and have a voluntary/nonprofit or government ownership model. After adjusting for age, gender, region, comorbidity burden and hospital-level characteristics, there were no significant differences between ranked vs unranked hospitals with regards to wound complications (1.2% vs 1.1%; p=0.907), cardiac complications (12.9% vs 11.9%; p=0.0553), pulmonary complications (3.7% vs 6.7%; p=0.654), urinary tract infections (7.3% vs 5.8%; p=0.120), sepsis (9.3% vs 7.9%; p=0.847), deep venous thrombosis (1.9% vs 1.3%; p=0.077), refusion/revision surgery (0.3% vs 0.3%; p=0.617) and all-cause readmissions (4.7% vs 4.4%; p=0.266). Patients undergoing surgery at ranked hospitals vs unranked hospitals had a slightly lower odds of experiencing renal complications (7.0% vs 4.9%; OR 1.11 [95% CI 1.00-1.22]; p=0.047); however, these findings were not clinically significant. Elective anterior cervical fusions at ranked hospitals, however, had significantly higher risk-adjusted 90-day charges (+ $17,053; p CONCLUSIONS Patients undergoing anterior cervical fusions at ranked hospitals, have similar outcomes as compared to unranked hospitals, even though the former facilities (ie, ranked hospitals) have significantly higher costs and charges over the 90-day episode of care. The findings support the need of a more objective and clinical-based approach towards applying ranks to hospitals. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.