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Spine Surgeon Specialty Is Not a Risk Factor for 30-Day Complication Rates in Single-Level Lumbar Fusion: A Propensity Score–Matched Study of 2528 Patients

Kim, Bobby D. MS*; Edelstein, Adam I. MD; Hsu, Wellington K. MD; Lim, Seokchun BS*; Kim, John Y. S. MD

doi: 10.1097/BRS.0000000000000394

Study Design. Multicenter retrospective cohort study.

Objective. To investigate the impact of spine surgeon specialty on 30-day complication rates in patients undergoing single-level lumbar fusion.

Summary of Background Data. Operative care of the spine is delivered by surgeons who undergo either orthopedic or neurosurgical training. It is currently unknown whether surgeon specialty has an impact on 30-day complication rates in patients undergoing single-level lumbar fusion.

Methods. The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify all patients who underwent single-level lumbar fusion procedures during 2006–2011. Propensity score matching analysis was employed to reduce baseline differences in patient characteristics. Univariate and multivariate analyses were performed to assess the impact of spine surgeon specialty on 30-day complication rates.

Results. A total of 2970 patients were included for analysis. After propensity matching, 1264 pairs of well-matched patients remained in the cohort. Overall complication rates in the unadjusted data set were 7.3% and 7.1% for the neurosurgery and orthopedic surgery cohort, respectively. Our multivariate analysis revealed that compared with the neurosurgery cohort, the orthopedic surgery cohort did not have statistically significant differences in odds ratios (OR) for development of any complication (OR, 0.95; 95% confidence interval [CI], 0.69–1.30; P = 0.740). Similarly, spine surgeon specialty was not a risk factor in any of the specific complications studied, including medical complications (OR, 1.11; 95% CI, 0.77–1.60; P = 0.583), surgical complications (OR, 0.76; 95% CI, 0.46–1.26; P = 0.287), or reoperation (OR, 1.10; 95% CI, 0.76–1.60; P = 0.618).

Conclusion. Our analysis demonstrates that spine surgeon specialty is not a risk factor for any of the reported 30-day complications in patients undergoing single-level lumbar fusion. These data support the currently dichotomous paradigm of training for spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.

Level of Evidence: 4

We present a review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP). The ACS-NSQIP database is a nationally validated resource containing deidentified patient information. In this study, we sought to examine the relationship between surgeon specialty and postoperative complications in the setting of single-level lumbar fusion.

*Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, IL; and

Departments of Orthopaedic Surgery and

Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL.

Address correspondence and reprint requests to John Y. S. Kim, MD, Department of Surgery, Northwestern University, Feinberg School of Medicine, 675 North St. Clair St, Galter Ste 19-250, Chicago, IL 60611; E-mail:

Acknowledgment date: December 17, 2013. Revision date: February 20, 2014. Acceptance date: April 15, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy.

© 2014 by Lippincott Williams & Wilkins