• World Neurosurg · Nov 2021

    Does the Specialty of the Surgeon Performing Elective Anterior/Lateral Lumbar Interbody Fusions for Degenerative Spine Disease Correlate with Early Perioperative Outcomes?

    • Safwan Alomari, Jose L Porras, LoSheng-Fu LSLDepartment of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA., Nicholas Theodore, Daniel M Sciubba, Timothy Witham, and Ali Bydon.
    • Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
    • World Neurosurg. 2021 Nov 1; 155: e111-e118.

    BackgroundComparative effectiveness research has a vital role in health reform and policies. Specialty training is one of these provider-side variables, and surgeons performing the same procedure who were trained in different specialties may have different outcomes. The objective of this study was to investigate the impact of spine surgeon specialty (neurosurgery vs. orthopedic surgery) on early perioperative outcome measures of elective anterior/lateral lumbar interbody fusion (ALIF/LLIF) for degenerative disc diseases.MethodsIn a retrospective, 1:1 propensity score-matched cohort study, 9070 patients were reviewed from the American College of Surgeons National Surgical Quality Improvement Program database. Propensity score matching and subgroup analysis were used.ResultsIn both groups (single-level and multilevel ALIF/LLIF), patients operated on by neurosurgeons had longer operative time (188 minutes vs. 172 minutes/239 minutes vs. 221 minutes); shorter total hospital stay (71 hours vs. 90 hours/89 hours vs. 96 hours); and lower rates of return to the operating room (2.1% vs. 4.1%/2.4% vs. 4.2%), nonhome discharge (8.7% vs. 11.1%/10.1% vs. 14.9%), discharge after postoperative day 3 (22.0% vs. 30.0%/38.0% vs. 43.9%), and perioperative blood transfusion (2.1% vs. 5.1%/5.0% vs. 9.9%) (P < 0.05). In multilevel ALIF/LLIF, patients operated on by neurosurgeons had lower readmission rates (3.9% vs. 6.9%) (P < 0.05). Other outcome measures and mortality rates were similar between the single-level and multilevel ALIF/LLIF cohorts regardless of surgeon specialty.ConclusionsOur analysis found significant differences in early perioperative outcomes of patients undergoing ALIF/LLIF by neurosurgeons and orthopedic surgeons. These differences have significant clinical and cost implications for patients, physicians, program directors, payers, and health systems.Copyright © 2021 Elsevier Inc. All rights reserved.

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