P111. Undergoing elective posterior lumbar fusions at “US News & World Report” ranked hospitals versus non-ranked hospitals: do rankings even matter?

Abstract

BACKGROUND CONTEXT The US News and World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying top hospitals for each specialty. However, due to recent methodological concerns on whether rankings are reflective of objective data, the rankings have been shrouded in controversy in the medical world. PURPOSE The current study aims to evaluate whether there are any differences in outcomes and costs for patients undergoing elective 1-to-3 level posterior lumbar fusions at ranked and non-ranked hospitals. STUDY DESIGN/SETTING Retrospective analysis of the 2010-2014 Medicare 100% Standard Analytical Files (SAF100) database. PATIENT SAMPLE The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in “Neurosurgery” and “Orthopedics.” Since 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 posterior lumbar fusions for degenerative spinal pathology. OUTCOME MEASURES Ninety-day outcomes and costs. METHODS The study cohort was divided into two groups, based on whether patients received surgery at a ranked hospital vs a non-ranked hospital. Multi-variate logistic and linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and non-ranked hospitals, while controlling for potential co-variates/confounders. RESULTS A total of 149,863 patients undergoing elective 1-to-3 level posterior lumbar fusions were included in the study, out of which 15,722 (10.5%) 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, greater bed size, be teaching hospitals and be located in a low socioeconomic area. After adjusting for age, gender, region, comorbidity burden and hospital-level characteristics, there were no significant differences between ranked vs non-ranked hospitals with regards to wound complications (4.6% vs 4.3%; p=0.299), cardiac complications (8.3% vs 7.8%; p=0.077), thromboembolic complications (3.0% vs 2.3%; p=0.208), pneumonia (2.0% vs 2.3%; p=0.482), urinary tract infections (10.6% vs 9.7%; p=0.109), renal complications (4.2% vs 4.0%; p=0.255), revision surgery (0.5% vs 0.4%; p=0.886) and all-cause readmissions (10.0% vs 10.0%; p=0.843). Patients undergoing surgery at ranked hospitals vs non-ranked hospitals had slightly lower odds of experiencing septic complications (1.0% vs 1.3%; OR 0.78 [95% CI 0.64-0.94]; p=0.010), however these findings were largely not clinically significant. Elective posterior lumbar fusions at ranked hospitals, however, had significantly higher risk-adjusted 90-day charges (+ 11,938; p CONCLUSIONS Elective posterior lumbar fusions at ranked hospitals have similar outcomes as compared to non-ranked hospitals, even though ranked hospitals have higher costs of care over the 90-day episode of care. The findings of the study support the need for a better clinical approach towards defining hospital rankings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.