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  • Assessing Variability in In-Hospital Complication Rates Between Surgical Specialties for Patients Undergoing Posterior Cervical Decompression and Fusion

    Final Number:

    Daniel J Snyder BS; Sean N Neifert BS; Jonathan S. Gal MD; Brian C. Deutsch BS; Robert J. Rothrock MD; Samuel Hunter BA; John M. Caridi MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Posterior cervical decompression and fusion (PCDF) is regularly performed by orthopedic and neurological surgeons, and recent literature has cited differences in surgical opinion and practice patterns between these two specialties. As PCDF has a relatively high rate of complications, the influence of surgical specialty on complication rates should be evaluated.

    Methods: All patients undergoing PCDF by a spine surgeon at a single institution between January 1, 2006 and November 30, 2016 were included. All patients in the NSQIP database undergoing PCDF by a spine surgeon between 2007 and 2015 were also included. Patients were identified by CPT code. Patients undergoing ACDF in the same hospital stay were identified by CPT code and excluded. Outcome variables were in-hospital complications. Cohorts were created based on the specialty of the primary surgeon. Categorical variables were compared using chi-square or Fisher’s Exact tests. A multivariable logistic regression model was also created including age, sex, ASA classification, and surgical specialty, with the outcome set as any in-hospital complication.

    Results: In both populations, a greater proportion of patients underwent PCDF by the neurological surgery service as opposed to the orthopedic surgery service (Single Institution: 55.94% vs. 44.06%; NSQIP: 78.32% vs. 21.68%). Patients in the orthopedic surgery service had a higher proportion of bleeding requiring transfusion in both the institutional sample (14.5% vs. 9.08%, p=0.003) and the national sample (11.16% vs. 6.18%, p<.0001). In the national sample, orthopedic surgeons were 1.66 times as likely to encounter an in-hospital complication than neurological surgeons (95% CI: 1.44 – 1.91, p<0.0001).

    Conclusions: When examining a large, national sample, this study demonstrates that orthopedic surgeons are more likely to encounter in-hospital complications than neurological surgeons when performing PCDF. The point of this study is to encourage inter-disciplinary collaboration to decrease in-hospital complications and improve patient outcomes.

    Patient Care: This study hopes to encourage inter-disciplinary collaboration between orthopedic and neurological surgeons to decrease in-hospital complications for patients undergoing posterior cervical decompression and fusion.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) state what significant differences exist in in-hospital complication rates between orthopedic and neurological surgeons performing posterior cervical decompression and fusion, and 2) identify areas where each discipline can help the other improve their care of posterior cervical decompression and fusion patients.


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