title: Variation in care among spinal deformity surgeons: results of a survey of the Shriners hospitals for children.
abstract: METHODS
  Survey.
  
  
  OBJECTIVE
  To understand the variation in scoliosis surgery and perioperative care among spinal deformity surgeons.
  
  
  BACKGROUND
  While variation in care has been well described in many spinal disorders, the degree of variation has not been described for spinal deformity.
  
  
  METHODS
  Clinical histories and radiographs of 4 typical spinal deformity patients were sent to spinal deformity surgeons for review. The cases consisted of idiopathic thoracolumbar, double major, and right thoracic curves and a neuromuscular lumbar curve. The survey queried choice of surgical approach, levels fused and instrumented, type of instrumentation, preoperative testing, intraoperative neurologic monitoring, blood and antibiotic use, and postoperative care, including pain control and patient mobilization. Cost estimates for each case were obtained from the individual hospitals' pricing.
  
  
  RESULTS
  There was wide variation in the specific fusion levels and instrumentation for the idiopathic curves. The variation was greatest for the thoracolumbar curve. The double major and right thoracic curves differed primarily in their choice of instrumenting secondary curves. The neuromuscular curve had the least variation. Costs estimates were widely disparate between centers. Perioperative care had much less disparity.
  
  
  CONCLUSIONS
  Agreement appears common in areas with readily identifiable outcomes such as shorter length of stay and rapid postoperative mobilization. However, agreement is poor in areas where outcomes are difficult to measure and require long-term follow-up such as instrumentation fusion and levels.
authors.affiliation: Shriners Hospitals for Children, Erie, PA 16505, USA. Jsanders@shrinenet.org
authors.forename: James O
authors.initials: JO
authors.lastname: Sanders
authors.forename: Richard
authors.initials: R
authors.lastname: Haynes
authors.forename: Don
authors.initials: D
authors.lastname: Lighter
authors.forename: Mark
authors.initials: M
authors.lastname: Niederpruem
authors.forename: Cheri
authors.initials: C
authors.lastname: Hollenback
authors.forename: Lillie
authors.initials: L
authors.lastname: Johnson
authors.forename: Stan
authors.initials: S
authors.lastname: Nomura
authors.forename: David
authors.initials: D
authors.lastname: Arndt
authors.forename: Pat
authors.initials: P
authors.lastname: Bush
authors.forename: Julius
authors.initials: J
authors.lastname: Santiago
authors.forename: Ron
authors.initials: R
authors.lastname: King
authors.forename: Tammy
authors.initials: T
authors.lastname: Trottier
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D009939:Organizations, Nonprofit / Q000191:economics / Q000592:standards; D009985:Orthopedics / Q000191:economics / Q000592:standards*; D010372:Pediatrics / Q000191:economics / Q000592:standards*; D012600:Scoliosis / Q000191:economics / Q000601:surgery*; D013123:Spinal Fusion; D013503:Surgery Department, Hospital / Q000191:economics / Q000592:standards*; D013904:Thoracic Vertebrae / Q000601:surgery