title: Surgeon specialty and outcomes after elective spine surgery.
abstract: METHODS
  Retrospective cohort analysis of prospectively collected clinical data.
  
  
  OBJECTIVE
  To compare outcomes of elective spine fusion and laminectomy when performed by neurological and orthopedic surgeons.
  
  
  BACKGROUND
  The relationship between primary specialty training and outcome of spinal surgery is unknown.
  
  
  METHODS
  We analyzed the 2006 to 2012 American College of Surgeons National Surgical Quality Improvement Project database of 50,361 patients, 33,235 (66%) of which were operated on by a neurosurgeon. We eliminated all differences in preoperative and intraoperative risk factors between surgical specialties by matching 17,126 patients who underwent orthopedic surgery (OS) to 17,126 patients who underwent neurosurgery (NS) on propensity scores. Regular and conditional logistic regressions were used to predict adverse postoperative outcomes in the full sample and matched sample, respectively. The effect of perioperative transfusion on outcomes was further assessed in the matched sample.
  
  
  RESULTS
  Diagnosis and procedure were the only factors that were found to be significantly different between surgical subspecialties in the full sample. We found that compared with patients who underwent NS, patients who underwent OS were more than twice as likely to experience prolonged length of stay (LOS) (odds ratio: 2.6, 95% confidence interval: 2.4-2.8), and significantly more likely to receive a transfusion perioperatively, have complications, and to require discharge with continued care. After matching, patients who underwent OS continued to have slightly higher odds for prolonged LOS, and twice the odds for receiving perioperative transfusion compared with patients who underwent NS. Taking into account perioperative transfusion did not eliminate the difference in LOS between patients who underwent OS and those who underwent NS.
  
  
  CONCLUSIONS
  Patients operated on by OS have twice the odds for undergoing perioperative transfusion and slightly increased odds for prolonged LOS. Other differences between surgical specialties in 30-day postoperative outcomes were minimal. Analysis of a large, multi-institutional sample of prospectively collected clinical data suggests that surgeon specialty has limited influence on short-term outcomes after elective spine surgery.
  
  
  METHODS
  3.
authors.affiliation: *Case Western Reserve University School of Medicine, Cleveland, OH †Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH ‡Departments of Pulmonary, Critical Care, and Sleep Medicine, University Hospitals, Cleveland, OH §Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH ¶The Department of Neurosurgery ‖The Spine Center, and **The Rose Ella Burkhardt Brain Tumor and Neurooncology Center, The Neurological Institute, Cleveland Clinic, Cleveland, OH; and ††Department of Neurosurgery, Geisinger Health System, Danville, PA.
authors.forename: Andreea
authors.initials: A
authors.lastname: Seicean
authors.forename: Nima
authors.initials: N
authors.lastname: Alan
authors.forename: Sinziana
authors.initials: S
authors.lastname: Seicean
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.forename: Edward C
authors.initials: EC
authors.lastname: Benzel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D000368:Aged; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000706:statistics & numerical data*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D015588:Observer Variation; D009985:Orthopedics / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome