Despite significant data heterogeneity, a new systematic review and meta-analysis has shown that both neurosurgeons and orthopaedic spine surgeons have similar readmission, complication, and reoperation rates regardless of the type of spine surgery performed.
The research, which was published in the journal Spine by Jose A. Canseco (Rothman Orthopaedic Institute, Philadelphia, USA) et al, was designed to identify if intraoperative or postoperative differences in outcomes exist between orthopaedic and neurological spine surgeons.
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines, a search of PubMed and Scopus databases was conducted and included articles comparing outcomes between orthopaedic spine surgeons and neurosurgeons. The Newcastle-Ottawa scale was used to determine the quality of studies. Forest plots were generated using mean differences (MD) for continuous variables and odds ratios (OR) for binomial variables, and 95% confidence intervals (CI) were reported.
From a total of 615 search term results, 16 studies were identified for inclusion. Evaluation of the studies found no differences in readmission rates (OR, ref: orthopaedics: 0.99 [95% CI, 0.901; 1.09]; I2=80%), overall complication rates (OR, ref: orthopaedics: 1.03 [95% CI, 0.97; 1.1]; I2=70%), reoperation rates (OR, ref: orthopaedics: 0.91 [95% CI, 0.82; 1]; I2=86%), or overall length of hospital stay between orthopaedic spine surgeons and neurosurgeons (MD -0.19 days [95% CI, -0.38; 0]; I2=98%).
However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions (OR, ref: orthopaedics: 0.49 [95% CI, 0.41; 0.57]; I2=75%), while orthopaedic spine surgeons had shorter operative times (MD: 14.28 minutes, [95% CI, 8.07; 20.49], I2=97%).
Speaking to Spinal News International, Canseco said: “Comparative effectiveness research is an important field of study that can help physicians improve patient and surgical outcomes. However, recent controversial literature within the spine field has unfortunately lacked a balanced perspective and served to strain the relationship between ortho and neuro spine surgeons.
“Thankfully, a multi-institutional collaboration, which included Rothman Orthopaedics at Thomas Jefferson University, Jefferson Neurosurgery, Duke Neurosurgery and Hopkins Orthopaedics, among others, demonstrated through the systematic review and meta-analysis highlighted here that ortho and neuro spine surgeons have similar outcomes and complications.
“Our multidisciplinary team, which includes Alex Vaccaro, Chris Shaffrey, Jim Harrop, Alan Hilibrand, Kal Kebaish and many other renowned ortho and neuro spine surgeons, strongly believes that improvements in patient and surgical outcomes will come with increased neurosurgeon and orthopaedic surgeon collaboration.
“Given the differences in training backgrounds, spine patients are more likely to benefit from the unique skills and views that each subspecialty brings to the table. Therefore, fostering healthy and collaborative relationships between neurosurgeons and orthopaedic spine surgeons, clinically and academically, will ultimately benefit patients, physicians and our healthcare system.”