Risk Factors for Spine Surgeon
Lumbar fusion is a frequently conducted surgery used to address various degenerative conditions of the spine that cause symptoms. Arthrodesis is a commonly utilized procedure that covers a diverse range of diagnostic indications.
These include addressing instability, deformity, stenosis, disc pathology, as well as providing relief for individuals experiencing chronic low back pain. The interconnected progress of surgical techniques, indications, and instrumentation has resulted in significant rises in the frequency of lumbar fusions.
The rates of complications associated with lumbar fusion have been reported to be as high as 13%, despite its widespread use. Research efforts remain concentrated on discovering evidence-based connections between risk factors and the rates of complications, emphasizing the importance of such associations.
The impact of the surgeon’s specialization on the occurrence of complications following lumbar fusion surgery is still not fully comprehended. While studies in various surgical disciplines have demonstrated variations in outcomes depending on the surgeon’s training, there is a dearth of comprehensive research specifically examining this aspect in relation to spine surgeons and the specific procedure of lumbar fusion.
Utilizing the extensive American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, researchers aimed to investigate whether there are discrepancies in 30-day complication rates following single-level lumbar fusion based on the surgeon’s specialty.
By analyzing data from over 250 private sector hospitals in the United States, the study specifically compared the outcomes between orthopedic surgery (OS) and neurosurgery (NS) specialists.
Lumbar fusion has become increasingly popular for treating degenerative conditions of the lumbar spine, but it poses risks of complications and mortality. Improving surgical outcomes requires identifying factors that may increase risk and optimizing them.
The study examined how the specialty of the spine surgeon affects the occurrence of postoperative complications within 30 days for patients undergoing single-level lumbar fusion. Despite considering other factors, the study revealed no correlation between surgeon specialty and an elevated risk of any of the examined complications within the 30-day timeframe.
The duration of training, the range of clinical cases encountered, and the role of post-residency fellowship training are notable differences between orthopedic and neurosurgical training for aspiring spine surgeons. These variations in training background can lead to divergent clinical decisions among spine surgeons.
Unadjusted analyses have indicated that orthopedic surgeons have a higher rate of performing fusions compared to their neurosurgical counterparts.
Furthermore, in specific countries, there may be a prevailing dominance of either orthopedic or neurosurgical subspecialties in delivering spine care. This situation could be influenced by the perceived complication rates and clinical outcomes associated with the distinct training backgrounds of each specialty.
Previous research has examined the impact of surgeon-related factors on surgical outcomes. In the field of general surgery, studies have demonstrated that surgeons who have completed additional fellowship training tend to have lower complication rates compared to those without such training.
This holds true for various procedures such as major pulmonary, esophageal operations, and carotid endarterectomy. Similarly, in the context of spine surgery, research has indicated that a higher volume of surgeries performed by a surgeon or hospital is linked to lower complication rates across a range of procedures.
Through a retrospective analysis, researchers have compared the rates of reoperation-free survival in patients undergoing surgery for degenerative lumbar spine conditions, taking into account the specialty of the surgeon. The analysis revealed no notable differences between orthopedic and neurosurgical cohorts.
Building upon these findings, studies reported in literature involve examining a comprehensive nationwide database for a specific procedure and confirming the absence of significant disparities in complication rates. These results strengthen the existing surgical care model for patients with lumbar spine conditions who require arthrodesis.
In a study reported by literature, various factors were identified that exhibited a significant correlation with overall complications, in addition to the spine surgeon’s specialty. These factors included age, BMI, dependent functional status, prior stroke, ASA class exceeding 2, and total operative duration.
It was particularly noteworthy that an increase in operative duration independently predicted a wide range of complications among patients undergoing single-level lumbar fusion. Furthermore, preoperative functional health status has consistently demonstrated an association with unfavorable outcomes in the field of general surgery.
Due to its design, the NSQIP database does not include procedure-specific or specialty-specific outcome variables, which hinders the ability to assess factors such as quality of life measures or radiographic parameters for comparison purposes.
The limited 30-day follow-up duration in the database hampers the tracking of complications or reoperations occurring after that period. Potential residual confounding may arise due to the limitations of the risk-adjusted models, which are constrained by the variables recorded in the database.
The database does not include surgeon- and hospital-level data, which limits their inclusion in the regression analysis. The coding protocol poses challenges in identifying and managing cases involving multiple surgical specialties. Furthermore, the analysis is susceptible to potential selection bias due to the lack of information on referral patterns.
Representing the first population-based inquiry of its kind, a comprehensive investigation is conducted to explore the impact of surgeon specialty in the realm of spinal surgery. According to an analysis reported in the literature, the specialty of the surgeon is not found to be a risk factor for any of the studied 30-day complications in patients undergoing single-level lumbar fusion.
These results provide validation for the current training model that spine surgeons adhere to. Additional research is necessary to verify this association in other types of spinal procedures and to assess various outcomes more comprehensively.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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