Spine surgeons, regardless of speciality, seem to achieve equivalent outcomes in mortality, 30-day readmission and surgical site infection rates, according to a new study published by Spine. However, the study did find notable differences in blood transfusion rates in procedures carried out by neurosurgeons and orthopaedic surgeons.
Brandon A McCutcheon, University of California San Diego, San Diego, California, led a cross-sectional analysis of the American College of Surgeons’ National Surgical Quality Improvement Program database from the period 2005–2011. The analysis focused on determining whether differences exist in 30-day rates of return to the operating room, mortality, and other perioperative outcomes for spinal fusion by specialty. According to McCutcheon and colleagues, “This is the most comprehensive study to date to assess whether perioperative outcomes in spine fusion are impacted by surgeon specialty.”
A total of 9,719 patients undergoing spinal fusion were identified. Of these, 54% had their operation completed by a neurosurgeon. Orthopaedic surgeons had practices with a greater percentage of lumbar spine cases (76% vs 65%, p<0.001). There was no statistically significant difference in the number of levels fused or operative technique used between the two specialties. There was also no difference in the majority of perioperative outcomes between orthopaedic surgeons and neurosurgeons including death, rate of return to the operating room, and other complications associated with significant morbidity.
“Clinical perioperative outcomes between orthopaedic spine surgeons and neurosurgeons were indistinguishable in this analysis,” report McCutcheon and colleagues. On unadjusted analysis, it was found that neurosurgeons were associated with a decreased incidence of operations requiring blood transfusion relative to orthopaedic surgeons (8.3% vs 14.6%, p<0.001). This trend persisted on multivariate analysis controlling for preoperative haematocrit, history of bleeding disorder, anatomical location of the operation, number of levels fused, operative technique, demographics, and comorbidities (odds ratio, 0.49; 95% confidence interval, 0.43–0.57).
“The difference in the use of blood transfusion is particularly interesting because it may reflect a therapeutic response to intraoperative blood loss (which may be related to technical factors not recorded in NSQIP and therefore beyond the scope of this study’s risk adjustment strategy) or to a specific training or emphasis on maintaining adequate haematocrit in the postoperative period,” suggest the authors. This difference is of clinical interest as it represents “a potentially modifiable practice pattern with clinical and cost implications.”
“Our analysis indicates that neurosurgical and orthopaedic surgeons performing spinal fusion have equivalent outcomes along several important measures including mortality and rate of return to the operating room,” conclude the study team.