title: High-Volume Hospitals and Surgeons Experience Fewer Early Reoperation Events After Adolescent Idiopathic Scoliosis Surgery.
abstract: METHODS
  Retrospective analysis of relevant in-hospital patient records from the New York State Inpatient Database.
  
  
  OBJECTIVE
  We aimed to assess reoperation risk in adolescent idiopathic scoliosis (AIS) by surgeon and hospital operative volume.
  
  
  BACKGROUND
  The need for early reoperation can be devastating for patient and family, is a burden to the physician and adds significant cost. Previous studies have shown improved outcomes associated with higher volume surgeons and hospitals, but reoperation events have not yet been explored.
  
  
  METHODS
  The 2008-2011 New York State Inpatient Database was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for adolescent idiopathic scoliosis patients aged 10-21 undergoing spine arthrodesis. Patient identifiers and revisit linkage variables were used to identify reoperation events. Annual surgeon and hospital volumes were stratified into tertiles (low, medium, high) via identifier codes. The relative risk of reoperation after spine arthrodesis was computed based on relevant patient inpatient stays.
  
  
  RESULTS
  Over 2008 to 2011, a total of 3,928 primary fusion operations for AIS were identified. The overall rate of reoperation after spine fusion for idiopathic scoliosis was 7.1%. Low volume surgeons performed less than 6 AIS fusions per year, medium volume surgeons performed less than 43, and high volume surgeons performed from 43 to 228. Reoperation after a primary fusion for adolescent idiopathic scoliosis showed reduced frequency among higher volume surgeons (14.1% for low vs. 5.1% for high, p<0.001, see Table for Hospitals).
  
  
  CONCLUSIONS
  Early reoperation after spine fusion for idiopathic scoliosis is seen more frequently in lower volume institutions and surgeons. Appreciating the resources and limitations at a clinician's institution is important to developing practices to prevent these devastating events. This work also has implications for strategies that aim to direct limited healthcare resources to centers with low complication rates.
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th Street, New York, NY, USA.
authors.forename: Justin C
authors.initials: JC
authors.lastname: Paul
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Beth Israel, 820 2nd Ave #7A, New York, NY, USA. Electronic address: blonner@nyc.rr.com.
authors.forename: Baron S
authors.initials: BS
authors.lastname: Lonner
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th Street, New York, NY, USA.
authors.forename: Shaleen
authors.initials: S
authors.lastname: Vira
authors.affiliation: Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th Street, New York, NY, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Errico
keywords: Adolescent idiopathic scoliosis; Reoperation; Volume