To the Editor
Dr Sun and colleagues1 performed a large database analysis of 66 430 overlapping surgical procedures. However, the challenges of large database studies include insufficiently granular data that may affect interpretation of the results.
The inclusion of THAs and spine procedures in the absence of diagnosis raises some concerns. It appears that the authors did not risk-adjust or differentiate cases based on the indication for surgery. For instance, THAs are increasingly being performed for hip fractures, and recent research has shown that THAs performed for a fracture have higher rates of postoperative complications and different resource utilization needs compared with THAs performed for hip osteoarthritis.2
The authors stated that they included patients undergoing thoracic, lumbar, or cervical spine surgery. Were these simple diskectomies, laminectomies, or decompressions? Or were these spinal fusions? Were these single-level or multilevel cases? All of these variables affect operative times and postoperative complications. Furthermore, what were the indications for the procedures? Were the procedures for degenerative spinal pathology (eg, spondylosis, spondylolisthesis) or were they performed for fractures or deformities? Even though the authors tried to limit long fusions by excluding thoracolumbar cases, further clarification is required. It is also unclear if these procedures were primary or revision cases, given that revision lumbar fusions are generally more complex procedures, known to be associated with higher rates of postoperative complications.3 Isolated thoracic spine surgery for elective degenerative pathology is relatively rare, which raises questions about whether these cases were performed for isolated thoracic deformities, neoplasms, infections, or trauma. Further clarification of the surgical approach (anterior vs posterior vs combined anterior-posterior spinal fusion) is also clinically important, as the approach may also affect operative times and outcomes.4,5
Grouping surgical procedures without risk-adjusting based on case complexity, using granular clinical data, makes it challenging to understand the safety implications of overlapping procedures.
Footnotes
Conflict of Interest Disclosures: Dr Quatman reported receiving grants from the National Institute on Aging and The Ohio State University Wexner Medical Center and receiving personal fees from Johnson & Johnson. No other disclosures were reported.
Contributor Information
Azeem Tariq Malik, The Ohio State University Wexner Medical Center, Columbus.
Carmen E. Quatman, The Ohio State University Wexner Medical Center, Columbus.
Scott Strassels, Department of Surgery, The Ohio State University, Columbus.
References
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