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More Experienced Surgeons Less Likely to Fuse: A Focus Group Review of 315 Hypothetical EOS Cases

Williams, Brendan A. BA*; Asghar, Jahangir MD; Matsumoto, Hiroko MA*; Flynn, John M. MD; Roye, David P. Jr MD*; Vitale, Michael G. MD, MPH*

doi: 10.1097/BPO.0b013e318279c501
Spine

Introduction: Previous work has identified significant variability in decision making and multiple areas of clinical equipoise in the treatment of early-onset scoliosis (EOS). In an attempt to better understand possible determinants of this variability, we examined the relationship between socioclinical attributes of 11 participating surgeons and decision making regarding the treatment of EOS.

Methods: Eleven experienced EOS surgeons were surveyed. The first part of the survey consisted of questions regarding surgeon and practice demographics. Next, surgeons were queried regarding their preferred management of 315 hypothetical EOS cases. Cases varied considerably in etiology [idiopathic, and low-tone and high-tone neuromuscular (HTNM)], age, and curve severity and progression. Treatment options were analyzed both individually and grouped as conservative (observation, bracing, or casting) versus surgical (spine-based or rib-based distraction, growth guidance, growth modulation, or definitive fusion). An “outlier” variable was created to determine the extent of a surgeon’s deviation from the group in management decisions. A univariate and multivariate regression analysis to identify statistical associations between physician characteristics and their management decisions in the presented hypothetical cases was performed.

Results: The cohort’s mean years in practice was 20.7±7.36 years. Fifty-six percent of the cohort held Chest Wall and Spine Deformity Study Group (CWSDSG) membership and 56% were members of the Growing Spine Study Group. Multivariate regression demonstrated more years of practice predicted a lower preference for fusion (P<0.05). This effect was greater among HTNM cases (P<0.05). Overall, there was equal interest among groups regarding the choice between rib-based and spine-based distraction methods; however, for the subset of patients with HTNM scoliosis, membership in the CWSDSG (P<0.05) and the percentage of practice spent treating spinal deformity (P<0.05) predicted more rib-based distraction use.

Conclusions: EOS surgeons with more experience were less likely to opt for definitive fusion. Use of rib-based distraction methods was common across surgeons in both study groups and within various cohorts of patients.

Level of Evidence: Level V (survey of experts).

*Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY

Division of Spinal Surgery, Miami Children’s Hospital, Coral Gables, FL

Division of Orthopaedics, Children’s Hospital of Philadelphia, Philadelphia, PA

Supported by a grant from The Chest Wall and Spine Deformity (CWSD) Research Foundation.

The authors declare no conflict of interest.

Reprints: Michael G. Vitale, MD, MPH, Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Ave. 8-North, New York, NY 10032. E-mail: mgv1@columbia.edu.

© 2013 Lippincott Williams & Wilkins, Inc.