Journal article
Surgeon-specific treatment selection bias and heterogeneous perioperative practices in an observational spine surgery study. A statistical tutorial with implications for analysis of observational studies of perioperative interventions
World neurosurgery, Vol.173, pp.e168-e179
05/2023
DOI: 10.1016/j.wneu.2023.02.027
PMCID: PMC12188842
PMID: 36773808
Abstract
It is essential that treatment effects reported from retrospective observational studies are as reliable as possible. In a retrospective analysis of spine surgery patients, we obtained a spurious result-tranexamic acid (TXA) had no effect on intraoperative blood loss. This statistical tutorial explains how this result occurred and why statistical analyses of observational studies must consider the effects of individual surgeons.
We utilized an observational database of 580 elective adult spine surgery patients, supplemented with a review of perioperative medication records. We tested whether common statistical methods-multivariable regression or propensity score-based methods-could adjust for surgeons' selection bias in TXA administration.
Because TXA administration (frequency, timing, and dose) and surgeon were linked (collinear), estimating and testing the independent effect of TXA on outcome using multivariable regression without including surgeon as a variable would provide biased (spurious) results. Likewise, because of surgeon/TXA linkage, assumptions of propensity-score based analysis were violated, statistical methods to improve comparability between groups failed, and spurious blood loss results were worsened. Others numerous differences among surgeons existed in intra- and post-operative practices and outcomes.
In observational studies in which individual surgeons determine whether their patients receive the treatment of interest, consideration must be given to inclusion of surgeon as an independent variable in all analyses. Failure to include the surgeon in an analysis of observational data carries a substantial risk of obtaining spurious results, either creating a spurious treatment effect or failing to detect a true treatment effect.
Details
- Title: Subtitle
- Surgeon-specific treatment selection bias and heterogeneous perioperative practices in an observational spine surgery study. A statistical tutorial with implications for analysis of observational studies of perioperative interventions
- Creators
- Bradley J Hindman - University of IowaColin J Gold - Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa, 52242, United States of AmericaEmanuel Ray - University of IowaLinder H Wendt - University of IowaPatrick Ten Eyck - Institute for Clinical and Translational Science, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa, 52242, United States of AmericaJoel I Berger - Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa, 52242, United States of AmericaCatherine R Olinger - University of IowaMatthew I Banks - University of Wisconsin School of Medicine and Public HealthRobert D SandersMatthew A Howard III - Department of Neurosurgery, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, Iowa, 52242, United States of AmericaRoyce W Woodroffe - University of Iowa
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.173, pp.e168-e179
- DOI
- 10.1016/j.wneu.2023.02.027
- PMID
- 36773808
- PMCID
- PMC12188842
- NLM abbreviation
- World Neurosurg
- eISSN
- 1878-8769
- Language
- English
- Electronic publication date
- 02/09/2023
- Date published
- 05/2023
- Academic Unit
- Neurology; Iowa Neuroscience Institute; Biostatistics; Orthopedics and Rehabilitation; Anesthesia; Neurosurgery; Otolaryngology
- Record Identifier
- 9984366155002771
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