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  • The Impact of Resident and Fellow Involvement in Adult Spinal Deformity Surgery

    Final Number:

    Scott L. Zuckerman MD; Nikita Lakomkin BA; Khoi Duc Than MD; Justin S. Smith MD PhD; Christopher I. Shaffrey MD, FACS; Clinton J. Devin MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Adult spinal deformity (ASD) operations are long and complex, often requiring a multi-surgeon team. Simultaneously, it is the responsibility of academic spine surgeons to train future complex spine surgeons. Our objective was to assess the impact of resident and fellow involvement on ASD surgery in the four areas of: 1) perioperative outcomes, 2) length of stay, 3) discharge status, and 4) complications.

    Methods: Adults who underwent thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Demographic characteristics were extracted. Cases were divided into those with resident/fellow involvement compared to attendings only. Outcomes of interest were: operative time, number of ransfusions, length of stay (LOS), discharge status, and complications. Univariate followed by multivariable regression modeling was used. Preoperative comorbidities, specialty, and levels fused were covariates.

    Results: A total of 1,461 patients underwent ASD surgery with orthopedics (707, 48.4%) or neurosurgery (754, 51.2%), with resident/fellow involvement in 778 (53%) operations. After multivariable regression modeling, five outcomes remained significant. Resident/fellow involvement was associated with longer operations (ß 66.01 minutes, 95%CI 35.82-96.19, p<0.001), increased odds of transfusion (OR 2.80, 95%CI 1.81-4.32, p<0.001), longer hospital stay (ß 1.76 days, 95% CI 0.18-3.34, p=0.030), and discharge to inpatient rehab or skilled nursing facility (OR 2.02, 95% CI 1.34-3.05, p<0.001). However, resident/fellow involvement was not associated with any increase in major or minor complications, nor specific complications of infection, pneumonia, DVT, PE, stroke, MI, or sepsis.

    Conclusions: Involvement of residents/fellows in ASD surgeries was associated with increased operative time, more transfusions, longer LOS, and non-home discharge; however, no increase in major or minor complications was seen. These preliminary data support the continued training of future deformity and complex spine surgeons without fear of worsening complications, yet areas of improvement exist.

    Patient Care: The current project can educate surgeons, patients, and hospitals that there are no differences in complications comparing ASD surgery with resident/fellow involvement compared to attending only. However, several areas of improvement exist.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Describe the differences in outcomes of patients undergoing ASD surgery with resident/fellow involvement compared to attendings only. 2. Discuss the implications of these findings on training future deformity and complex spine surgeons.


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