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Back & Neck Spine Surgery Volumes & Outcomes

Volume of Back & Neck Spine Procedures

What are we measuring?

The number of back and neck surgical procedures (excluding spinal fusions reported separately) performed each year by BIDMC Spine Center surgeons. Surgical spine procedures of the back and neck include: 

  • Laminectomies - surgery to remove a small portion of a vertebra (back bone). The part removed is called the lamina. 
  • Discectomies- surgery that removes part of the inter-vertebral discs located between each backbone (vertebra); usually to decompress a nerve root on the spinal cord.   

Why is this important

Studies have found that surgical teams with experience - that is, routinely performing a sufficient number of cases - get better results.

What is our performance telling us?

The chart below shows the total number of back and neck procedures performed at BIDMC by Spine Center surgeons during Fiscal Years 2009, 2010, and 2011.

Back & Neck Surgery Length of Stay

What are we measuring?

The average number of days a patient undergoing back or neck surgery stays in the hospital.

Why is this important?

The number of days that surgery patients must stay in the hospital is a way of looking at both the efficiency of care as well as its effectiveness. A shorter average length of stay may indicate that patients are recovering more quickly and experiencing fewer complications. However, it is important to consider how extensive the surgery is that is being performed. For example, average length of stay does not take into account how ill the patients are, or that not everyone is a candidate for minimally invasive surgery such as microdiscectomy which, on average, has a lower length of stay because it is less invasive.

What is our performance telling us?

The chart below shows the average length of stay for patients undergoing back and neck surgical procedures during Fiscal Years 2009, 2010, and 2011.

In FY 2009, BIDMC's average Length of Stay (LOS) for patients undergoing back and neck surgical procedures was 2.0; in FY 2010 it was 1.8 days, and in FY 2011 it was 2.2 days. While there are no nationally recognized benchmarks for Length of stay, BIDMC provides this performance data as additional information for our patients.

What we are doing to improve?

The Spine Center surgical team is working closely with the nursing staff, physical therapists, and case managers to decrease length of stay when appropriate and ensuring that all patients meet the criteria for a successful discharge from the hospital.

Back & Neck Surgery Complications

Complications are rare, but no procedure is completely free of risk. At BIDMC, we take steps to prevent complications and we carefully monitor our performance. Presented below are complication performance measures associated with Back and Neck surgical procedures. The Spine Center measures complications using the definitions provided by Blue Cross Blue Shield as part of BIDMC's designation as a Blue Distinction Center for Spine Surgery SM

What are we measuring?

The percentage of back and neck surgeries with complications arising from intra operative dural tears (tear of the sac covering the nerves).

Why is this important

Dural tears have not been shown to have significant long term impact, Dural tears which occur during surgery can lengthen the patient's stay in the hospital and slow down the initial recovery from surgery.

What is our performance telling us?

The chart below shows the percentage of complications arising from intra-operative dural tears among patients undergoing back and neck spine procedures during Fiscal Years 2009, 2010 and 2011.

In FY 2009, the percentage of back and neck procedures in which a dural tear occurred was 6.9%; in FY 2010, the dural tear complication percentage was 2.6%; and in FY 2011, this rate was 6.7%.

Published medical studies indicate that an inter-operative dural tear rate between 2% and 10% depending on the type and complexity of the procedures performed.

What are we doing to improve?

Dural tears are a risk associated with spine surgery, particularly in certain types of spinal procedures. As an academic teaching hospital, we often have more complex patient cases that are referred to us from community-based physicians and hospitals.

Prior to surgery, our patients receive information and education regarding the risk for dural tears, how tears are effectively treated, and any post-surgery problems.

During surgery, our surgical team carefully monitors for dural tears, so that if they occur, the tear is repaired immediately, during the surgery, so that the need for additional surgery or extended recovery time is reduced or eliminated.

Unplanned Reoperations and Readmissions

What are we measuring?

Unplanned Reoperations within 30 days of initial operation

The percentage of Back & Neck surgery patients who undergo an unplanned reoperation related to their back or neck surgery within 30 days of their initial operation. Unplanned reoperations may occur for many reasons including infection, epidural hematoma, or recurrent disc herniation or other reasons related to their initial back or neck surgery.

Unplanned Readmissions within 30 days of initial discharge

The percentage of Back & Neck surgical cases requiring unplanned readmission to BIDMC within 30 days of initial discharge. Unplanned readmissions are due to a condition related to the original back or neck spine surgery, and include surgical site infections.

Why is this important?

We continuously strive to deliver the best outcomes for our patients admitted to BIDMC for spine surgery. 30-day Unplanned Reoperation and 30-day Unplanned Readmission Rates are two measures relate to the quality of care provided to patients while under going surgery and hospitalized and in the transition of care after surgery. Our goal is to prevent avoidable reoperations and readmissions.

What is our performance telling us?

The chart below shows the percentage of patients having un-planned reoperations related to their initial back or neck surgical procedure during Fiscal Years 2009, 2010 and 2011.

In FY 2009, 4.6% of patients needed an additional unplanned reoperation within 30 days of their original surgery due to complications arising from their initial back or neck surgery; in FY 2010, 1.0% of patients underwent unplanned reoperations; and in FY 2011, 7.1% of patients underwent unplanned reoperations within 30 days of their original surgery. 

The chart below shows the percentage of patients experiencing an un-planned readmission related to their initial back or neck surgical procedure within 30-days of their initial discharge for Fiscal Years 2008, 2009 and 2010.
In FY 2009, 3.5% of patients experiencing an unplanned readmissions due to complications arising from their initial back or neck surgery within 30 days of their original surgery. In FY 2010, 3.6% of patients experiencing an unplanned readmissions; and in FY 2011, 6.7% of patients experienced an unplanned readmission within 30 days of their initial discharge due to complications arising from their initial surgery.

What we are doing to improve?

Reoperations and readmissions are among the most frustrating experiences for spine surgery patients. Among the most common reasons for reoperation or readmission is a surgical site infection.

At BIDMC, we are committed to reducing surgical site infections and have implemented a core set of specific actions to eliminate preventable surgical site infections.  When taken together, these specific actions (called "bundles") typically result in consistently better outcomes than if each these actions were performed individually. Learn more about surgical site infection prevention at BIDMC.

Actions in the infection prevention "bundle" include: 

  1. Appropriate use of antibiotics just prior to and during surgery. 
  2. Appropriate hair removal at the surgical site using clippers. 
  3. Use of antimicrobial washes and preps prior to surgery by patients. 
  4. Use of antiseptic scrub in the Operating Room, immediately prior to surgery.

Prior to discharge, the Spine Center team works closely with hospital nursing staff, physical therapists, and patient case managers to ensure that patients are ready to leave the hospital.  BIDMC is working on improving communication and post discharge care coordination between the hospital and patients, their families, and community-based healthcare providers (such as visiting nurses and primary care physicians). These efforts will help patients and their caregivers successfully follow post-hospitalization treatment and care guidance.

Last Updated March 14, 2012

Contact Information

Silverman Institute for Health Care Quality and Safety
Beth Israel Deaconess Medical Center
330 Brookline Ave
Boston, MA 02215
617-667-1325