title: Perioperative Outcome in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Prospective Study Comparing Single Versus Two Attending Surgeons Strategy.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  To evaluate the perioperative outcome of posterior spinal fusion in adolescent idiopathic scoliosis (AIS) patients comparing a single attending surgeon strategy (G1) versus a dual attending surgeon strategy (G2).
  
  
  BACKGROUND
  The complication rate for surgical correction in AIS is significant. There are no prospective studies that investigate dual attending surgeon strategy for posterior spinal fusion in AIS.
  
  
  METHODS
  A total of 60 patients (30 patients in each arm) were recruited. The patients were comparable for age, gender, Lenke classification, major Cobb angle magnitude, and number of fusion levels. The anesthetic, surgical, and postoperative protocol was standardized. The outcome measures included the operative duration, blood loss, postoperative hemoglobin, need for transfusion, morphine usage, duration of hospital stay, intraoperative lactate levels, and pH. The timing of the operation at six critical stages of the operation was recorded.
  
  
  RESULTS
  The mean operative time for G2 was 173.6 ± 27.0 minutes versus 248.0 ± 49.9 minutes in G1 (P < 0.000). Mean blood loss in G2 was 0.92 ± 0.4 L and 1.25 ± 0.6 L in G1 (P < 0.05). None of the patients in G2 required any allogenic transfusion. Four patients in G1 (13.3%) required allogenic blood product transfusion. The day 2 postoperative hemoglobin levels in both groups were similar, but this was taken after blood product transfusion in G1. The amount of morphine usage was 20.4 ± 11.5 mg in G2 and 42.5 ± 24.0 mg in G1 (P < 0.000). G2 patients had a shorter hospital stay. One patient in G1 had superficial wound infection. G2 was faster than G1 during exposure, instrumentation, facetectomy, and bone grafting.
  
  
  CONCLUSIONS
  The involvement of two attending surgeons significantly reduced operative time, blood loss, need for allogenic blood transfusion, patient-controlled analgesia morphine requirement and led to faster patient recovery during the perioperative period.
  
  
  METHODS
  2.
authors.affiliation: Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chris Yin Wei
authors.initials: CYW
authors.lastname: Chan
authors.forename: Mun Keong
authors.initials: MK
authors.lastname: Kwan
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008505:Medical Staff, Hospital / Q000639:trends; D000069471:Neurosurgeons / Q000639:trends; D061646:Operative Time; D011446:Prospective Studies; D012600:Scoliosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult