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Surgeon Specialty and Outcomes After Elective Spine Surgery

Seicean, Andreea, MPH, PhD*,†; Alan, Nima, BS*; Seicean, Sinziana, MD, PhD, MPH‡,§; Neuhauser, Duncan, PhD; Benzel, Edward C., MD¶,‖; Weil, Robert J., MD¶,**,††

doi: 10.1097/BRS.0000000000000489

Study Design. Retrospective cohort analysis of prospectively collected clinical data.

Objective. To compare outcomes of elective spine fusion and laminectomy when performed by neurological and orthopedic surgeons.

Summary of Background Data. The relationship between primary specialty training and outcome of spinal surgery is unknown.

Methods. We analyzed the 2006 to 2012 American College of Surgeons National Surgical Quality Improvement Project database of 50,361 patients, 33,235 (66%) of which were operated on by a neurosurgeon. We eliminated all differences in preoperative and intraoperative risk factors between surgical specialties by matching 17,126 patients who underwent orthopedic surgery (OS) to 17,126 patients who underwent neurosurgery (NS) on propensity scores. Regular and conditional logistic regressions were used to predict adverse postoperative outcomes in the full sample and matched sample, respectively. The effect of perioperative transfusion on outcomes was further assessed in the matched sample.

Results. Diagnosis and procedure were the only factors that were found to be significantly different between surgical subspecialties in the full sample. We found that compared with patients who underwent NS, patients who underwent OS were more than twice as likely to experience prolonged length of stay (LOS) (odds ratio: 2.6, 95% confidence interval: 2.4–2.8), and significantly more likely to receive a transfusion perioperatively, have complications, and to require discharge with continued care. After matching, patients who underwent OS continued to have slightly higher odds for prolonged LOS, and twice the odds for receiving perioperative transfusion compared with patients who underwent NS. Taking into account perioperative transfusion did not eliminate the difference in LOS between patients who underwent OS and those who underwent NS.

Conclusion. Patients operated on by OS have twice the odds for undergoing perioperative transfusion and slightly increased odds for prolonged LOS. Other differences between surgical specialties in 30-day postoperative outcomes were minimal. Analysis of a large, multi-institutional sample of prospectively collected clinical data suggests that surgeon specialty has limited influence on short-term outcomes after elective spine surgery.

Level of Evidence: 3

Patients who undergo elective spine surgery have slightly increased odds for prolonged lengths of hospital stay and perioperative transfusion when operated upon by an orthopedic surgeon compared with those who undergo operation by a neurosurgeon. Other 30-day, perioperative, and postoperative outcomes are similar.

*Case Western Reserve University School of Medicine, Cleveland, OH

Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH

Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals, Cleveland, OH

§Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH

The Department of Neurosurgery

The Spine Center, and

**The Rose Ella Burkhardt Brain Tumor and Neurooncology Center, The Neurological Institute, Cleveland Clinic, Cleveland, OH; and

††Department of Neurosurgery, Geisinger Health System, Danville, PA.

Address correspondence and reprint requests to Andreea Seicean, MPH, PhD, c/o ND4-40 LRI/Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; E-mail:

Acknowledgment date: September 23, 2013. First revision date: March 2, 2014. Second revision date: April 29, 2014. Acceptance date: April 29, 2014

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

The Melvin Burkhardt chair in neurosurgical oncology, and the Karen Colina Wilson research endowment within the Brain Tumor and Neurooncology Center at the Cleveland Clinic funds were received to support the work of R.J.W., in part. The funders of this philanthropic support had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Relevant financial activities outside the submitted work: royalties.

© 2014 by Lippincott Williams & Wilkins