Complications, Readmissions, and Revisions for Spine Procedures Performed by Orthopedic Surgeons Versus Neurosurgeons: A Retrospective, Longitudinal Study.
METHODS
Retrospective database analysis.


OBJECTIVE
To examine the impact of training pathway, either neurosurgical or orthopedic, on complications, readmissions, and revisions in spine surgery.


BACKGROUND
Training pathway has been shown to have an impact on outcomes in various surgical subspecialties. Although training pathway has not been shown to have a significant impact on spine surgery outcomes in the perioperative period, long-term results are unknown.


METHODS
A retrospective analysis of 197,682 patients receiving 1 of 3 common spine surgeries [lumbar laminectomy, lumbar fusion, and anterior cervical discectomy and fusion (ACDF)] between 2006 and 2010 was conducted. Patient data were obtained from a large claims database. Postoperative adverse effects, all-cause readmission, revision surgery rates, and intermediary payments in these cohorts of patients were compared between spine surgeons with either neurosurgical or orthopedic backgrounds.


RESULTS
Patient demographics, hospital-stay characteristics, and medical comorbidities were similar between neurosurgeons and orthopedic surgeons. The risks of surgical complications, all-cause readmission, and revision surgery were also similar between neurosurgeons and orthopedic surgeons across all procedure types assessed, with several minor exceptions: neurosurgeons had marginally higher odds of any complication for lumbar fusions [odds ratio (OR) 1.14; 95% confidence interval (CI), 1.09-1.20] and ACDFs (OR, 1.09; 95% CI, 1.04-1.15). Neurosurgeons also had slightly higher rates of revision surgery for concurrent lumbar laminectomy with fusion (OR, 1.14; 95% CI, 1.08-1.22), and ACDFs (OR, 1.20; 95% CI, 1.14-1.28). No associations between surgeon type and any particular complication were consistently observed for all procedure groups. There were also no associations between surgeon type and 30-day all-cause readmission. Median total intermediary payments were somewhat higher for neurosurgery patients for all procedure groups assessed.


CONCLUSIONS
Few significant associations between surgeon type and patient outcomes exist in the context of spine surgery. Those which do are small and unlikely to be clinically meaningful.


METHODS
Level 3.
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Tarub
T
Mabud
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Justin
J
Norden
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Anand
A
Veeravagu
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Christian
C
Swinney
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
Tyler
T
Cole
Department of Neurosurgery, Mayo Clinic, Rochester, MN.
Brandon A
BA
McCutcheon
Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA.
John
J
Ratliff
D005260:Female; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects* / Q000191:economics; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D000072161:Orthopedic Surgeons / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000191:economics