• Justin K Scheer, Rajiv K Sethi, Lloyd A Hey, Michael O LaGrone, Malla Keefe, Henry E Aryan, Thomas J Errico, Vedat Deviren, Robert A Hart, Virginie Lafage, Frank Schwab, Michael D Daubs, Christopher P Ames, and and the SRS Adult Spinal Deformity Committee.
• *University of California San Diego, School of Medicine, La Jolla, CA †Virginia Mason Medical Center, University of Washington, Seattle, WA ‡Hey Clinic, Raleigh, NC §Private practice, Amarillo, TX ¶Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA ||Department of Neurosurgery, Sierra Pacific Orthopedics, Fresno, CA **Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, NY ††Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA ‡‡Department of Orthopedic Surgery, Oregon Health & Science University, Portland, OR §§Spine Service, Hospital for Special Surgery, New York, NY ¶¶University of Nevada, School of Medicine, Las Vegas, NV.
• Spine. 2017 Jun 15; 42 (12): 932-942.

Study DesignAn electronic survey administered to Scoliosis Research Society (SRS) membership.ObjectiveTo characterize surgeon practices and views regarding the use of two attending surgeons for adult spinal deformity (ASD) surgery.Summary Of Background DataThe use of two experienced attending surgeons can decrease the operative time, estimated blood loss, and perioperative complication rates. However, the current practice patterns for the use of two attending surgeons remains unknown.MethodsAn electronic, 27-question survey regarding single/dual attending surgeons was administered to the SRS membership. Determinants included: surgeon/practice demographics, assistant type/level of training, and questions regarding use of two attending surgeons. Overall reporting and comparisons between groups were made: US versus international, academic versus private practice, and experience <15 years versus >15 years.ResultsA total of 199 surgeons responded from 27 different countries. Overall and between the groups, the respondents significantly reported believing that two attending spine surgeons improves safety, decreases complications, and improves outcomes (P < 0.01). Approximately, 67.3% reported using a second attending ≤25% of the time (33.2% do not), and 24.1% use one ≥51% of the time (similar between groups); 51.1% that have a second attending feel it's limited by reimbursement and access concerns and 71.9% have difficulty getting the second attending reimbursed. 72.3% use a second attending for ALL of the following reasons (no difference between groups): "it's safer/reduces complications," "it decreases operative time," "it decreases blood loss," "it results in improved outcomes," "it's less work and stress for me." If reimbursement was equal/assured for a second attending, 67.5% would use one "more often" or "always."ConclusionThe respondents feel that having a second attending surgeon improves patient care, however most do not use one often. Reasons include reimbursement/access concerns and the majority would use one if reimbursement was equal and assured. Based on the current literature and these results, there is a need for working with third party payers to improve dual surgeon reimbursement rates in complex cases.Level Of Evidence5.

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