title: Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To assess the perioperative morbidity of pedicle subtraction osteotomy (PSO) based on the presence of 1 versus 2 attending surgeons.
  Pedicle subtraction osteotomies are challenging cases with high complication rates and substantial physiological burden on patients. The literature supports the benefits of 2-surgeon strategies in complex cases in other specialties.
  
  
  METHODS
  We reviewed a single institution database of all pedicle subtraction osteotomies (78 cases) from 2005-2010 and divided the cohort into single versus 2-surgeon groups (42 vs. 36 cases, respectively). We performed subset analysis after excluding cases before 2007 and excluding patients with staged anterior and posterior procedures. We analyzed cases for estimated blood loss, length of surgery, length of stay, radiographic analysis, rate of return to the operating room within 30 days, and medical and neurological complications.
  
  
  RESULTS
  The groups were similar when comparing mean number of posterior levels fused, levels decompressed and revision rates, however, the average age of the single surgeon and 2 surgeon groups was 57.6 and 64.3 years, respectively (p = .02). The 2 groups had comparable correction of radiographic parameters. Mean percent estimated blood loss for single versus 2 surgeons was 109% versus 35% (p < .001) and estimated blood loss was 5,278 versus 2,003 mL (p < .001). Average surgical time for single versus 2 surgeons was 7.6 versus 5.0 hours (p < .001). A total of 45% of single-surgeon patients compared with 25% of 2-surgeon patients experienced at least 1 major complication within 30 days. In the single-surgeon group, 19% had unplanned surgery within 30 days, versus 8% in the 2-surgeon group.
  
  
  CONCLUSIONS
  The use of 2 surgeons at an experienced spine deformity center decreases the operative time and estimated blood loss, and may be a key factor in witnessed decreased major complication prevalence. This approach also may decrease the rate of premature case termination and return to operating room in 30 days.
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, RM M-779, Box 0112, San Francisco, CA 94143-0112, USA. Electronic address: AmesC@neurosurg.ucsf.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MUW 314, Box 0728, San Francisco, CA 94143-0112, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Barry
authors.affiliation: Department of Neurological Surgery, University of California, 505 Parnassus Avenue, RM M-779, Box 0112, San Francisco, CA 94143-0112, USA.
authors.forename: Sassan
authors.initials: S
authors.lastname: Keshavarzi
authors.affiliation: Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MUW 314, Box 0728, San Francisco, CA 94143-0112, USA.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Dede
authors.affiliation: Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MUW 314, Box 0728, San Francisco, CA 94143-0112, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weber
authors.affiliation: Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MUW 314, Box 0728, San Francisco, CA 94143-0112, USA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
keywords: Blood loss; Multiple surgeons; Pedicle subtraction osteotomy; Perioperative outcomes; Spinal deformity