Introduction: In spite of potential training differences, both neurological and orthopedic surgeons operate on the spine. No prior studies have assessed whether spine surgery outcomes differ by specialty. In this comparative effectiveness study we assessed the effect of specialty of early peri-operative outcomes in patients undergoing spine surgery.
Methods: We analyzed the 2006-2011 American College of Surgeons National Surgical Quality Improvement Project (NSQIP) prospective database of 41,711 patients, of which 27,492 (65.9%) were operated on by neurosurgeons and 14,219 (34.1%) by orthopedic surgeons. Pre- and intraoperative characteristics and 30-day outcomes were stratified by age. Using propensity scores and exact current procedural terminology (CPT) codes, 11,038 orthopedic surgery patients were matched precisely to 11,038 neurosurgery patients. Logistic regression was used to predict adverse postoperative outcomes. Sensitivity analyses were conducted altering the matching restriction criteria and liming the patient sample to individual CPT codes.
Results: Prior to matching, patients operated on by orthopedic surgeons had slightly higher odds for prolonged length of hospitalization (LOS) (1.4; 95% CI 1.3-1.5) and 30-day return to the operating room (1.2; 95% CI 1.1-1.3) but lower odds for 30-day mortality (0.6; 95% CI 0.5-0.9). After matching and adding the remaining unbalanced covariates to the model, prolonged LOS remained significantly different between surgical specialties with patients operated on by orthopedic surgeons having 1.3 (95% CI 1.2-1.4) times the odds for prolonged LOS compared with those operated on by neurosurgeons. Sensitivity analyses confirmed these findings.
Conclusions: While patients operated on by orthopedic surgeons having slightly greater odds for prolonged LOS, other differences between surgical specialties in 30-day postoperative outcomes for patients undergoing spine surgery were minimal. Using a large multi-institutional sample of prospectively-collected data, our findings suggest that surgeon specialty has limited predictive value for spine surgery short-term outcomes.
Patient Care: This analysis will provide insight into potential similarities and differences in care for patients with spine disorders and, potentially, enhance continue collaboration between specialists.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the differences in 30-day morbidity and mortality between patients undergoing spine surgery by orthopedic vs. neurological surgeons.