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Two Surgeon Approach for Complex Spine Surgery

Rationale, Outcome, Expectations, and the Case for Payment Reform

Bauer, Jennifer M., MD, MS; Yanamadala, Vijay, MD, MBA; Shah, Suken A., MD; Sethi, Rajiv K., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 1, 2019 - Volume 27 - Issue 9 - p e408–e413
doi: 10.5435/JAAOS-D-17-00717
Review Article

There is an increased trend in complex spine deformity cases toward a two attending surgeon approach, but the practice has not become widely accepted by payers. Multiple studies have shown that spine surgery complications increase with the duration of case, estimated blood loss, and use of transfusions, as well as in certain high-risk populations or those requiring three-column osteotomies. Dual-surgeon cases have been shown to decrease estimated blood loss, transfusion rate, surgical times, and therefore complication rates. Although this practice comes at an uncertain price to medical training and short-term costs, the patient's quality of care should be prioritized by institutions and payers to include dual-surgeon coverage for these high-risk cases. Because we enter an era where the value of spine care and demonstrating cost-effectiveness is essential, dual surgeon attending approaches can enhance these tenets.

From Seattle Children's Hospital, University of Washington Department of Orthopaedics and Sports Medicine, Seattle, WA (Dr. Bauer), Montefiore Medical Center, Department of Neurological Surgery, Albert Einstein College of Medicine, New York, NY (Dr. Yanamadala), University of Washington, Virginia Mason Medical Center, Seattle, WA (Dr. Sethi), and Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE (Dr. Shah).

Dr. Bauer or an immediate family member serves as a paid consultant to Johnson & Johnson. Dr. Shah or an immediate family member has received royalties from DePuy Synthes Spine and K2M; serves as a paid consultant to DePuy Synthes Spine, NuVasive, and Stryker; has stock or stock options held in Globus Medical and Innovative Surgical Designs; has received research or institutional support from DePuy Synthes Spine, K2M, and NuVasive; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the Scoliosis Research Society, the Pediatric Orthopaedic Society of North America, and the Setting Scoliosis Straight Foundation. Dr. Sethi or an immediate family member serves as a paid consultant to K2M, NuVasive, and Orthofix and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from K2M. Neither Dr. Yanamadala nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

© 2019 by American Academy of Orthopaedic Surgeons
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