A new article published in Spine examines the factors impacting 30-day perioperative outcomes for spinal fusion by specialty using the NSQIP database.
There were 9,719 patients who received spinal fusions by either orthopedic surgeons or neurosurgeons in the American College of Surgeons' National Surgical Quality Improvement Program database between 2005 and 2011. There were 54 percent treated by neurosurgeons. The researchers found:
1. Orthopedic surgeons performed more lumbar cases — 76 percent — versus neurosurgeons — 65 percent.
2. There weren't statistically significant differences in the number of levels fused between orthopedic surgeons and neurosurgeons. The techniques both specialists chose were also similar.
3. Perioperative outcomes were similar, for the most part, between orthopedic surgeons and neurosurgeons. The death rate, return to the operating room and other complications associated with significant morbidity were similar.
4. Neurosurgeons had fewer operations requiring blood transfusions — 8.3 percent — than orthopedic surgeons — 14.6 percent. The same was true when controlling for preoperative hematocrit history of bleeding disorder, anatomic operation location, levels fused, operative technique, demographics and comorbidities.
5. The researchers concluded that both specialists had similar metrics for mortality, 30-day readmission and surgical site infection. "Observed differences in blood transfusion rates by specialty were noted, but the cause of this difference is unclear and warrants further investigation to assess the impact of this difference, if any, on patient outcomes and cost," they concluded.