Differences in management of isolated spinal fractures between neurosurgery and orthopaedics: a 6-year retrospective study

Myers, Matthew; Hall, Samuel; Sadek, Ahmed‐Ramadan; Dare, Christopher; Griffith, Colin; Shenouda, Emad; Nader-Sepahi, Ali

doi:10.1080/02688697.2020.1763256

Cited by 3 publications

(26 citation statements)

References 20 publications

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“…Neurosurgeons had significantly shorter LOS in 3 studies 3,4,11. The remaining studies found no difference in LOS 10,19,26. The meta-analysis also found no difference in LOS [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%].…”

Section: Resultsmentioning

confidence: 84%

“…Of 10 studies that compared complications, 8 (80.0%)8–12,20,21,25 found no difference in complication rates between subspecialties 8–12,20–22,25,26. Mabud et al 22 found a lower overall complication rate for orthopedics for lumbar fusions (14.5% vs .…”

Section: Resultsmentioning

confidence: 99%

“…3,4,11 The remaining studies found no difference in LOS. 10,19,26 The metaanalysis also found no difference in LOS [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%]. After the removal of the studies most influenced by heterogeneity, LOS was significantly shorter for orthopedic spine surgeons and there was less data heterogeneity [MD: 0.13 days (95% CI: 0.08, 0.18]; I 2 = 66%] (Figure 5, Supplemental File D, Supplemental Digital Content 6, http://links.lww.com/BRS/C17, Supplemental Digital Content 7, http://links.lww.com/BRS/C18).…”

Section: Length Of Staymentioning

confidence: 99%

“…Of 10 studies that compared complications, 8 (80.0%) [8][9][10][11][12]20,21,25 found no difference in complication rates between subspecialties. [8][9][10][11][12][20][21][22]25,26 Mabud et al 22 found a lower overall complication rate for orthopedics for lumbar fusions (14.5% vs. 16.2%) and anterior cervical discectomy and fusion (ACDF) (9.9% vs. 10.5%). Myers et al 26 found a lower complication rate for neurosurgery (14.3% vs. 22.6%).…”

Section: Complicationsmentioning

confidence: 99%

“…[8][9][10][11][12][20][21][22]25,26 Mabud et al 22 found a lower overall complication rate for orthopedics for lumbar fusions (14.5% vs. 16.2%) and anterior cervical discectomy and fusion (ACDF) (9.9% vs. 10.5%). Myers et al 26 found a lower complication rate for neurosurgery (14.3% vs. 22.6%). Snyder et al 12 did not find a difference in their single-institution data analyzing posterior cervical decompression and fusion (OR, ref:neurosurgery:1.29, P = 0.11), but found a higher rate of complications for orthopedics when analyzing complications from NSQIP (OR, ref: neurosurgery:1.66, P < 0.0001).…”

Section: Complicationsmentioning

confidence: 99%

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Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Lambrechts

Canseco

Toci

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis to identify if intraoperative or postoperative differences in outcomes exist between orthopedic and neurological spine surgeons. Summary of Background Data. Spine surgeons may become board certified through orthopedic surgery or neurosurgical residency training, and recent literature has compared surgical outcomes between surgeons based on residency training background with conflicting results. Materials and Methods. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a search of PubMed and Scopus databases was conducted and included articles comparing outcomes between orthopedic spine surgeons and neurosurgeons. The Newcastle-Ottawa scale was used to determine the quality of studies. Forest plots were generated using mean differences (MD) for continuous variables and odds ratios (OR) for binomial variables, and 95% CI was reported. Results. Of 615 search term results, 16 studies were identified for inclusion. Evaluation of the studies found no differences in readmission rates [OR, ref: orthopedics: 0.99 (95% CI: 0.901, 1.09); I 2 = 80%], overall complication rates [OR, ref: orthopedics: 1.03 (95% CI: 0.97, 1.10); I 2 = 70%], reoperation rates [OR, ref: orthopedics: 0.91 (95% CI: 0.82, 1.00); I 2 = 86%], or overall length of hospital stay between orthopedic spine surgeons and neurosurgeons [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%]. However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions [OR, ref: orthopedics: 0.49 (95% CI: 0.41, 0.57); I 2 = 75%] while orthopedic spine surgeons had shorter operative times [MD: 14.28 minutes, (95% CI: 8.07, 20.49), I 2 = 97%]. Conclusions. Although there is significant data heterogeneity, our meta-analysis found that neurosurgeons and orthopedic spine surgeons have similar readmission, complication, and reoperation rates regardless of the type of spine surgery performed.

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Section: Resultsmentioning

confidence: 84%

Section: Resultsmentioning

confidence: 99%

Section: Length Of Staymentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Lambrechts

Canseco

Toci

et al. 2023

Spine

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Natural Experiments as a Study Method in Spinal Trauma Surgery: A Systematic Review

Stadhouder,

van Rossenberg,

Kik

et al. 2023

Global Spine Journal

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Study Design Systematic review. Objectives To determine if the natural experiment design is a useful research methodology concept in spinal trauma care, and to determine if this methodology can be a viable alternative when randomized controlled trials are either infeasible or unethical. Methods A Medline, Embase and Cochrane database search was performed between 2004 and 2023 for studies comparing different treatment modalities of spinal trauma. All observational studies with a natural experiment design comparing different treatment modalities of spinal trauma were included. Data extraction and quality assessment with the MINORS criteria was performed. Results Four studies with a natural experiment design regarding patients with traumatic spinal fractures were included. All studies were retrospective, one study collected follow-up data prospectively. Three studies compared different operative treatment modalities, whereas one study compared different antibiotic treatment strategies. Two studies compared preferred treatment modalities between expertise centers, one study between departments (neuro- and orthopedic surgery) and one amongst surgeons. For the included retrospective studies, MINORS scores (maximum score 18) were high ranging from 12-17 and with a mean (SD) of 14.6 (1.63). Conclusions Since 2004 only four studies using a natural experiment design have been conducted in spinal trauma. In the included studies, comparability of patient groups was high emphasizing the potential of natural experiments in spinal trauma research. Natural experiments design should be considered more frequently in future research in spinal trauma as they may help to address difficult clinical problems when RCT’s are infeasible or unethical.

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Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders

Kuruba,

Cherukuri,

Arul

et al. 2023

Cureus

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Spinal surgical procedures are steadily increasing globally due to broad indications of certain techniques encompassing a wide spectrum of conditions, including degenerative spine disorders, congenital anomalies, spinal metastases, and traumatic spinal fractures. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the clinical adeptness to perform these procedures. With the advancing focus on comparative effectiveness research, it is vital to compare patient outcomes in spine surgeries performed by orthopedic surgeons and neurosurgeons, given their distinct approaches and training backgrounds to guide hospital programs and physicians to consider surgeon specialty when making informed decisions. Our review of the available literature revealed no significant difference in postoperative outcomes in terms of blood loss, neurological deficit, dural injury, intraoperative complications, and postoperative wound dehiscence in procedures performed by neurosurgeons and orthopedic surgeons. An increase in blood transfusion rates among patients operated by orthopedic surgeons and a longer operative time of procedures performed by neurosurgeons was a consistent finding among several studies. Other findings include a prolonged hospital stay, higher hospital readmission rates, and lower cost of procedures in patients operated on by orthopedic surgeons. A few studies revealed lower sepsis rates unplanned intubation rates and higher incidence of urinary tract infections (UTIs) and pneumonia postoperatively among patient cohorts operated by neurosurgeons. Certain limitations were identified in the studies including the use of large databases with incomplete information related to patient and surgeon demographics. Hence, it is imperative to account for these confounding variables in future studies to alleviate any biases. Nevertheless, it is essential to embrace a multidisciplinary approach integrating the surgical expertise of the two specialties and develop standardized management guidelines and techniques for spinal disorders to mitigate complications and enhance patient outcomes.

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Differences in management of isolated spinal fractures between neurosurgery and orthopaedics: a 6-year retrospective study

Cited by 3 publications

References 20 publications

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Natural Experiments as a Study Method in Spinal Trauma Surgery: A Systematic Review

Specialty Impact on Patient Outcomes: Paving a Way for an Integrated Approach to Spinal Disorders

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