Spine surgeon specialty is not a risk factor for 30-day complication rates in single-level lumbar fusion: a propensity score-matched study of 2528 patients

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2014-07, Vol.39 (15), p.E919-E927
• Main Authors: Kim, Bobby D, Edelstein, Adam I, Hsu, Wellington K, Lim, Seokchun, Kim, John Y S
• Format: Article
• Language: English
• Subjects: Adult; Aged; Databases, Factual - statistics & numerical data; Female; Humans; Lumbar Vertebrae - surgery; Male; Middle Aged; Multivariate Analysis; Neurosurgery - standards; Neurosurgery - statistics & numerical data; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Orthopedic Procedures - adverse effects; Orthopedic Procedures - methods; Orthopedics - standards; Orthopedics - statistics & numerical data; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Postoperative Complications - etiology; Propensity Score; Retrospective Studies; Risk Factors; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgeons - standards; Surgeons - statistics & numerical data; Time Factors
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0000000000000394

Multicenter retrospective cohort study. To investigate the impact of spine surgeon specialty on 30-day complication rates in patients undergoing single-level lumbar fusion. Operative care of the spine is delivered by surgeons who undergo either orthopedic or neurosurgical training. It is currently unknown whether surgeon specialty has an impact on 30-day complication rates in patients undergoing single-level lumbar fusion. The American College of Surgeons National Surgical Quality Improvement Program database was retrospectively reviewed to identify all patients who underwent single-level lumbar fusion procedures during 2006-2011. Propensity score matching analysis was employed to reduce baseline differences in patient characteristics. Univariate and multivariate analyses were performed to assess the impact of spine surgeon specialty on 30-day complication rates. A total of 2970 patients were included for analysis. After propensity matching, 1264 pairs of well-matched patients remained in the cohort. Overall complication rates in the unadjusted data set were 7.3% and 7.1% for the neurosurgery and orthopedic surgery cohort, respectively. Our multivariate analysis revealed that compared with the neurosurgery cohort, the orthopedic surgery cohort did not have statistically significant differences in odds ratios (OR) for development of any complication (OR, 0.95; 95% confidence interval [CI], 0.69-1.30; P = 0.740). Similarly, spine surgeon specialty was not a risk factor in any of the specific complications studied, including medical complications (OR, 1.11; 95% CI, 0.77-1.60; P = 0.583), surgical complications (OR, 0.76; 95% CI, 0.46-1.26; P = 0.287), or reoperation (OR, 1.10; 95% CI, 0.76-1.60; P = 0.618). Our analysis demonstrates that spine surgeon specialty is not a risk factor for any of the reported 30-day complications in patients undergoing single-level lumbar fusion. These data support the currently dichotomous paradigm of training for spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes. 4.