Introduction: Lumbar discectomy is a common procedure performed by orthopedic and neurological surgeons. While previous studies have examined preoperative risk factors and the impact of outpatient surgery versus inpatient admission on postoperative complications, the impact of surgeon specialty has not been examined. This study investigates the impact of surgeon specialty on 30-day postoperative complication rates for single-level lumbar discectomies.
Methods: All patients who underwent single-level lumbar discectomy between 2005 and 2014 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity-score matching and univariate binary regression was utilized to determine if surgeon subspecialty had an impact on 30-day post-operative complications.
Results: 28,863 patients underwent single-level lumbar discectomies from 2005-2014. 12,659 cases met inclusion criteria. 3,733 (29.4%) operations were performed by orthopedic surgeons, while 8,926 (70.6%) were performed by neurosurgeons. A propensity-score matched sample of 7,464 total cases (3,732 orthopedic surgeon, 3,732 neurosurgeon) was analyzed for impact of surgeon specialty on 30-day outcomes. After propensity matching, orthopedic surgeons and neurosurgeons were similar in all post-operative outcomes, except for a slightly higher frequency of blood transfusions (0.3%, n = 11) in orthopedic versus neurosurgery patients (0.1%, n = 3; p = 0.032), although this did not remain significant after Bonferroni adjustment. Mean operative time was slightly longer for neurosurgeons (83.7min) versus orthopedic surgeons (72.5min; p < 0.001). There were no significant differences in mortality, readmission, or reoperation rates.
Conclusions: Single-level lumbar discectomies hold a low complication profile and show equivalent outcomes for both orthopedic and neurological surgeons, although neurosurgeons may exhibit a slightly longer mean operative time. In propensity-score matched cohorts, orthopedic surgeons had slightly higher rates of blood transfusions, although the number was small and did not remain significant after Bonferroni adjustment.
Patient Care: Single level lumbar discectomies are among the most common spine operations performed in the United States, with both neurosurgeons and orthopedic surgeons performing the procedure. Despite their frequency, the two specialties have not been compared for outcomes. This review of almost 30,000 patients compares the two specialties and finds a low, comparable complication rate for each, with a slightly higher transfusion rate in orthopedic surgeons and longer operative time in neurosurgeons.
This research will improve care by informing the surgeon of common complications for this procedure and patient risk factors predictive of poor outcomes, aiding decision making and allowing them to better counsel patients prior to surgery. It also reinforces the two specialties as relatively equivalent in outcomes, informing patients and insurers that both provider specialties are appropriate for this common procedure.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Characterize common complications after single-level discectomies and their frequency of occurrence.
2) Compare and contrast different outcomes for single-level discectomies performed by neurosurgeons versus those performed by orthopedic surgeons.
3) Appreciate the low, comparable, complication risk for both surgical specialties, slightly higher transfusion rate in orthopedic surgeons, and slightly longer operative time in neurosurgeons.