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Assessing Variability in In-Hospital Complication Rates Between Surgical Services for Patients Undergoing Posterior Cervical Decompression and Fusion

Snyder, Daniel J., BS; Neifert, Sean N., BS; Gal, Jonathan S., MD; Deutsch, Brian C., BS; Rothrock, Robert, MD; Hunter, Samuel, MD; Caridi, John M., MD‡,§

doi: 10.1097/BRS.0000000000002780
CERVICAL SPINE
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Study Design. A retrospective study was performed including all patients who underwent posterior cervical decompression and fusion (PCDF) by an orthopedic or neurological surgeon at a single institution between January 1, 2006 and November 30, 2016, and all patients who underwent PCDF by a spine surgeon in the National Surgical Quality Improvement Project database between 2007 and 2015. In-hospital complications were compared between surgical specialties.

Objective. The goal of this study was to determine if in-hospital complication rates differ significantly between surgical services for PCDF patients.

Summary of Background Data. Orthopedic and neurological surgeons commonly perform PCDF, and differences in surgical opinion and management have been cited between these two specialties in recent literature. This represents a variable that should be evaluated.

Methods. Cases were preliminarily identified by CPT code and confirmed using the ICD-9 code 81.03 or ICD-10 code M43.22. Cases were separated based on if the primary surgeon was an orthopedic surgeon or a neurological surgeon. The primary outcome variable was in-hospital complication rates; cohorts were compared using bivariate and multivariate analysis.

Results. A total of 1221 patients at a single institution and 11,116 patients within the National Surgical Quality Improvement Project database underwent PCDF. Patients in the orthopedic surgery service had a higher proportion of bleeding requiring transfusion in both the institutional sample (14.5% vs. 9.08%, P = 0.003) and national sample (11.16% vs. 6.18%, P < 0.0001). In the national sample, orthopedic surgeons were 1.66 times as likely to encounter an in-hospital complication than neurological surgeons (95% CI: 1.44–1.91, P < 0.0001).

Conclusion. When examining a large institutional sample and an even larger national sample, this study found that orthopedic surgeons were more likely to encounter perioperative bleeding requiring transfusion than neurological surgeons. When in-hospital complications were considered as a whole, in the national sample, orthopedic surgeons are more likely to encounter in-hospital complications than neurological surgeons when performing PCDF.

Level of Evidence: 3

Orthopedic and neurological surgeons commonly perform PCDF; differences in surgical opinion and management have been cited between these two specialties. When examining an institutional (n = 1221) and national sample (n = 11,116), orthopedic surgeons were more likely to have in-hospital complications, in particular perioperative bleeding requiring transfusion, than neurological surgeons when performing PCDF.

Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY

Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY

Department of Neurosurgery, Mount Sinai Hospital, New York, NY

§Department of Orthopedics, Mount Sinai Hospital, New York, NY.

Address correspondence and reprint requests to Daniel J. Snyder, BS, Icahn School of Medicine at Mount Sinai, 50 East 98th Street, Room 9C-3, New York, NY 10029; E-mail: Daniel.Snyder@Icahn.Mssm.Edu

Received 11 April, 2018

Revised 12 June, 2018

Accepted 18 June, 2018

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, grants.

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