title: Comparison of perioperative parameters and complications observed in the anterior exposure of the lumbar spine by a spine surgeon with and without the assistance of an access surgeon.
abstract: BACKGROUND
  The anterior approach to the spine is becoming an increasingly important avenue to treat spine conditions. Most of the literature reporting on the exposure uses an access surgeon assisting the spine surgeon to expose and prepare the spine for implant.
  
  
  OBJECTIVE
  To compare perioperative parameters and complications in anterior lumbar spine surgery with the exposure performed either by a spine surgeon or a general surgeon.
  
  
  METHODS
  A retrospective cohort study comparing perioperative parameters and complications of anterior lumbar spine surgery.
  
  
  METHODS
  A retrospective review was completed on 96 consecutive patients who underwent anterior spine surgery between Levels L3 and S1 from 1995 to 2008. Patient and surgery characteristics including demographics, comorbidities, perioperative parameters, and complications were logged. In the first 56 consecutive patients, a general surgeon completed the exposure, with an additional patient who later had the exposure performed by a general surgeon because of extensive prior abdominal surgeries. In the next 39 patients, the orthopedic surgeon completed the exposure.
  
  
  RESULTS
  When the operation was performed solely by a spine surgeon, the estimated blood loss, operative time, and hospital stay was 204 mL, 2.80 hours, and 3.5 days, respectively. In the procedures completed with the aid of a general surgeon, it was found that the same parameters were 420 mL, 3.93 hours, and 4.7 days, respectively, and statistically significantly less in the group without the assistance of the general surgeon (p=.0007, p=.0003, and p=.0006, respectively). Fewer complications also were observed in that group (p<.00001). The most common complication was an ileus. Major complications including retrograde ejaculation, iliac vein bleeding, peritoneal rent requiring repair, dyspareunia, or scrotal/penile swelling were only observed in the group with the assistance of the general surgeon.
  
  
  CONCLUSIONS
  This study indicated that a spine surgeon can successfully and safely carry out the anterior exposure to the spine without the aid of an access surgeon.
authors.affiliation: Stanford University Hospital and Clinics, Department of Orthopaedic Surgery, 450 Broadway Street, Redwood City, CA 94063-6342, USA. wabashspine@gmail.com
authors.forename: Micah W
authors.initials: MW
authors.lastname: Smith
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Rahn
authors.forename: Robert M
authors.initials: RM
authors.lastname: Shugart
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Belschner
authors.forename: Kary S
authors.initials: KS
authors.lastname: Stout
authors.forename: Ivan
authors.initials: I
authors.lastname: Cheng
mesh_terms: D000328:Adult; D017586:Diskectomy / Q000379:methods; D005260:Female; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D010348:Patient Care Team / Q000706:statistics & numerical data*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods