Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Author:

Lambrechts Mark J.1,Canseco Jose A.1ORCID,Toci Gregory R.1ORCID,Karamian Brian A.1,Kepler Christopher K.1,Smith Michael L.1,Schroeder Gregory D.1,Hilibrand Alan S.1,Heller Joshua E.2,Grasso Giovanni3,Gottfried Oren4,Kebaish Khaled M.5,Harrop James S.2,Shaffrey Christopher4,Vaccaro Alexander R.1

Affiliation:

1. Department of Orthopedic Surgery, Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA

2. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA

3. Department of Biomedicine, Neurosurgical Unit, Neurosciences and Advance Diagnostics, University of Palermo, Palermo, Italy

4. Department of Neurosurgery, Duke University Medical Center, Durham, NC

5. Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, MD

Abstract

Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis to identify if intraoperative or postoperative differences in outcomes exist between orthopedic and neurological spine surgeons. Summary of Background Data. Spine surgeons may become board certified through orthopedic surgery or neurosurgical residency training, and recent literature has compared surgical outcomes between surgeons based on residency training background with conflicting results. Materials and Methods. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a search of PubMed and Scopus databases was conducted and included articles comparing outcomes between orthopedic spine surgeons and neurosurgeons. The Newcastle-Ottawa scale was used to determine the quality of studies. Forest plots were generated using mean differences (MD) for continuous variables and odds ratios (OR) for binomial variables, and 95% CI was reported. Results. Of 615 search term results, 16 studies were identified for inclusion. Evaluation of the studies found no differences in readmission rates [OR, ref: orthopedics: 0.99 (95% CI: 0.901, 1.09); I 2 = 80%], overall complication rates [OR, ref: orthopedics: 1.03 (95% CI: 0.97, 1.10); I 2 = 70%], reoperation rates [OR, ref: orthopedics: 0.91 (95% CI: 0.82, 1.00); I 2 = 86%], or overall length of hospital stay between orthopedic spine surgeons and neurosurgeons [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%]. However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions [OR, ref: orthopedics: 0.49 (95% CI: 0.41, 0.57); I 2 = 75%] while orthopedic spine surgeons had shorter operative times [MD: 14.28 minutes, (95% CI: 8.07, 20.49), I 2 = 97%]. Conclusions. Although there is significant data heterogeneity, our meta-analysis found that neurosurgeons and orthopedic spine surgeons have similar readmission, complication, and reoperation rates regardless of the type of spine surgery performed.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Orthopedics and Sports Medicine

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