Adult Scoliosis Deformity Surgery

Comparison of Outcomes Between 1 vs. 2 Attending Surgeons

International Spine Study Group

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

STUDY DESIGN.: Retrospective review of prospectively collected data. OBJECTIVE.: Assess outcomes of adult spinal deformity (ASD) surgery performed by 1 vs. 2 attending surgeons. SUMMARY OF BACKGROUND DATA.: ASD centers have developed 2-attending teams in order to improve efficiency; their effects on complications and outcomes have not been reported. METHODS.: ASD patients with ≥5 levels fused and?>?2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (HRQOL) and X-rays were analyzed. Outcomes were compared between 1-surgeon (1S) and 2-surgeon (2S) centers. A deformity-matched cohort was analyzed. RESULTS.: 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the SRS-Schwab classification (p?<?0.05). There were no significant differences in levels fused (p?=?0.57), LOS (8.7 vs. 8.9 days), OR time (445.9 vs. 453.2?min) or EBL (2008 vs. 1898 cc; p?>?0.05). 2S patients had more 3-column osteotomies (3CO; p?<?0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9 vs. 15.6%; p?<?0.001). The 2S group had fewer intra-operative complications (1.3 vs. 11.1%; p?=?0.006). Post-operative (6-weeks to 2-year) complications were more frequent in the 2S group (4.8 vs. 15.6%; p?<?0.002). After matching for deformity, there were no differences in LOS (9.1 vs. 10.1 days), OR time (467.8 vs. 508.4?min) or EBL (3045 vs. 2247 cc; p?=?0.217). 2S group used less BMP-2 (20.6 vs. 84.8%; p?<?0.001), had fewer intra-operative complications (p?=?0.015) but post-operative complications due to instrumentation failure/pseudarthrosis were more frequent (p?<?0.01). CONCLUSIONS.: No significant differences were found in LOS, OR time or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intra-operative complications but more post-operative complications.Level of Evidence: 2

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Jan 16 2017

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Scoliosis
Operating Rooms
Length of Stay
Surgeons
Bone Morphogenetic Protein 2
Pseudarthrosis
Osteotomy
Quality of Life
X-Rays

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Adult Scoliosis Deformity Surgery : Comparison of Outcomes Between 1 vs. 2 Attending Surgeons. / International Spine Study Group.

In: Spine, 16.01.2017.

Research output: Contribution to journalArticle

@article{5d5e3e1a39ac4affbc2460b1c752db42,
title = "Adult Scoliosis Deformity Surgery: Comparison of Outcomes Between 1 vs. 2 Attending Surgeons",
abstract = "STUDY DESIGN.: Retrospective review of prospectively collected data. OBJECTIVE.: Assess outcomes of adult spinal deformity (ASD) surgery performed by 1 vs. 2 attending surgeons. SUMMARY OF BACKGROUND DATA.: ASD centers have developed 2-attending teams in order to improve efficiency; their effects on complications and outcomes have not been reported. METHODS.: ASD patients with ≥5 levels fused and?>?2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (HRQOL) and X-rays were analyzed. Outcomes were compared between 1-surgeon (1S) and 2-surgeon (2S) centers. A deformity-matched cohort was analyzed. RESULTS.: 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the SRS-Schwab classification (p?<?0.05). There were no significant differences in levels fused (p?=?0.57), LOS (8.7 vs. 8.9 days), OR time (445.9 vs. 453.2?min) or EBL (2008 vs. 1898 cc; p?>?0.05). 2S patients had more 3-column osteotomies (3CO; p?<?0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9 vs. 15.6{\%}; p?<?0.001). The 2S group had fewer intra-operative complications (1.3 vs. 11.1{\%}; p?=?0.006). Post-operative (6-weeks to 2-year) complications were more frequent in the 2S group (4.8 vs. 15.6{\%}; p?<?0.002). After matching for deformity, there were no differences in LOS (9.1 vs. 10.1 days), OR time (467.8 vs. 508.4?min) or EBL (3045 vs. 2247 cc; p?=?0.217). 2S group used less BMP-2 (20.6 vs. 84.8{\%}; p?<?0.001), had fewer intra-operative complications (p?=?0.015) but post-operative complications due to instrumentation failure/pseudarthrosis were more frequent (p?<?0.01). CONCLUSIONS.: No significant differences were found in LOS, OR time or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intra-operative complications but more post-operative complications.Level of Evidence: 2",
author = "{International Spine Study Group} and Gomez, {Jaime A.} and Virginie Lafage and Scuibba, {Daniel M.} and Shay Bess and Mundis, {Gregory M.} and Barthelemy Liabaud and Regina Hanstein and Christopher Shaffrey and Michael Kelly and Christopher Ames and Smith, {Justin S.} and Passias, {Peter G.} and Thomas Errico and Frank Schwab",
year = "2017",
month = "1",
day = "16",
doi = "10.1097/BRS.0000000000002071",
language = "English (US)",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Adult Scoliosis Deformity Surgery

T2 - Comparison of Outcomes Between 1 vs. 2 Attending Surgeons

AU - International Spine Study Group

AU - Gomez, Jaime A.

AU - Lafage, Virginie

AU - Scuibba, Daniel M.

AU - Bess, Shay

AU - Mundis, Gregory M.

AU - Liabaud, Barthelemy

AU - Hanstein, Regina

AU - Shaffrey, Christopher

AU - Kelly, Michael

AU - Ames, Christopher

AU - Smith, Justin S.

AU - Passias, Peter G.

AU - Errico, Thomas

AU - Schwab, Frank

PY - 2017/1/16

Y1 - 2017/1/16

N2 - STUDY DESIGN.: Retrospective review of prospectively collected data. OBJECTIVE.: Assess outcomes of adult spinal deformity (ASD) surgery performed by 1 vs. 2 attending surgeons. SUMMARY OF BACKGROUND DATA.: ASD centers have developed 2-attending teams in order to improve efficiency; their effects on complications and outcomes have not been reported. METHODS.: ASD patients with ≥5 levels fused and?>?2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (HRQOL) and X-rays were analyzed. Outcomes were compared between 1-surgeon (1S) and 2-surgeon (2S) centers. A deformity-matched cohort was analyzed. RESULTS.: 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the SRS-Schwab classification (p?<?0.05). There were no significant differences in levels fused (p?=?0.57), LOS (8.7 vs. 8.9 days), OR time (445.9 vs. 453.2?min) or EBL (2008 vs. 1898 cc; p?>?0.05). 2S patients had more 3-column osteotomies (3CO; p?<?0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9 vs. 15.6%; p?<?0.001). The 2S group had fewer intra-operative complications (1.3 vs. 11.1%; p?=?0.006). Post-operative (6-weeks to 2-year) complications were more frequent in the 2S group (4.8 vs. 15.6%; p?<?0.002). After matching for deformity, there were no differences in LOS (9.1 vs. 10.1 days), OR time (467.8 vs. 508.4?min) or EBL (3045 vs. 2247 cc; p?=?0.217). 2S group used less BMP-2 (20.6 vs. 84.8%; p?<?0.001), had fewer intra-operative complications (p?=?0.015) but post-operative complications due to instrumentation failure/pseudarthrosis were more frequent (p?<?0.01). CONCLUSIONS.: No significant differences were found in LOS, OR time or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intra-operative complications but more post-operative complications.Level of Evidence: 2

AB - STUDY DESIGN.: Retrospective review of prospectively collected data. OBJECTIVE.: Assess outcomes of adult spinal deformity (ASD) surgery performed by 1 vs. 2 attending surgeons. SUMMARY OF BACKGROUND DATA.: ASD centers have developed 2-attending teams in order to improve efficiency; their effects on complications and outcomes have not been reported. METHODS.: ASD patients with ≥5 levels fused and?>?2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (HRQOL) and X-rays were analyzed. Outcomes were compared between 1-surgeon (1S) and 2-surgeon (2S) centers. A deformity-matched cohort was analyzed. RESULTS.: 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the SRS-Schwab classification (p?<?0.05). There were no significant differences in levels fused (p?=?0.57), LOS (8.7 vs. 8.9 days), OR time (445.9 vs. 453.2?min) or EBL (2008 vs. 1898 cc; p?>?0.05). 2S patients had more 3-column osteotomies (3CO; p?<?0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9 vs. 15.6%; p?<?0.001). The 2S group had fewer intra-operative complications (1.3 vs. 11.1%; p?=?0.006). Post-operative (6-weeks to 2-year) complications were more frequent in the 2S group (4.8 vs. 15.6%; p?<?0.002). After matching for deformity, there were no differences in LOS (9.1 vs. 10.1 days), OR time (467.8 vs. 508.4?min) or EBL (3045 vs. 2247 cc; p?=?0.217). 2S group used less BMP-2 (20.6 vs. 84.8%; p?<?0.001), had fewer intra-operative complications (p?=?0.015) but post-operative complications due to instrumentation failure/pseudarthrosis were more frequent (p?<?0.01). CONCLUSIONS.: No significant differences were found in LOS, OR time or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intra-operative complications but more post-operative complications.Level of Evidence: 2

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