Spine surgeon specialty differences in single-level percutaneous kyphoplasty

Abstract

BackgroundPercutaneous kyphoplasty (PKP) is a procedure performed by a spine surgeon who undergoes either orthopedic or neurosurgical training. The relationship between short-term adverse outcomes and spine specialty is presently unknown. To compare short-term adverse outcomes of single-level PKP when performed by neurosurgeons and orthopedic surgeons in order to develop more concretely preventive strategies for patients under consideration for single-level PKP.MethodsWe evaluated patients who underwent single-level PKP from 2012 to 2014 through the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP). We used univariate analysis and multivariate logistic regression to assess the association between spine surgeon specialty and short-term adverse events, including postoperative complication and unplanned readmission, and to identify different independent risk predictors between two specialties.ResultsOf 2248 patients who underwent single-level PKP procedure, 1229 patients (54.7%) had their operations completed by a neurosurgeon. There were no significant differences in the development of the majority of postoperative complications and the occurrence of unplanned readmission between the neurosurgical cohort (NC) and the orthopedic cohort (OC). A difference in the postoperative blood transfusion rate (0.7% NS vs. 1.7% OC, P = 0.039) was noted and may due to the differences in comorbidities between patients. Multivariate regression analysis revealed different independent predictors of postoperative adverse events for the two spine specialties.ConclusionsBy comparing a large range of demographic feature, preoperative comorbidities, and intraoperative factors, we find that short-term adverse events in single-level PKP patients does not affect by spine surgeon specialty, except that the OC had higher postoperative blood transfusion rate. In addition, the different perioperative predictors of postoperative complications and unplanned readmissions were identified between the two specialties. These findings can lead to better evidence-based patient counseling and provide valuable information for medical evaluation and potentially devise methods to reduce patients’ risk.

Cement Augmentation of Vertebral Compression Fractures May Be Safely Considered in the Very Elderly

“…To our knowledge, there are no previous studies comparing the outcomes of orthopedic surgeons and neurosurgeons performing cement augmentation procedures using a large cohort of patients. We found no difference between the outcomes of the various populations with regards to operator specialty training, consistent with prior studies indicating no differences between the groups [ 30 ]. Similar results have been reported with regards to elective lumbar and cervical spine procedures as well [ 31 - 33 ].…”

“…We found no difference between the outcomes of the various populations with regards to operator specialty train- ing, consistent with prior studies indicating no differences between the groups. 30 Similar results have been reported with regards to elective lumbar and cervical spine procedures as well. [31][32][33] There are several limitations to the current study.…”

Spine Surgical Subspecialty and Its Effect on Patient Outcomes

“…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 .…”

“…Ten studies reported on readmission rates after surgery 3,4,7,8,10,11,19,21–23. Eight did not detect differences in readmission rates 7,8,10,11,19,21–23. Of the studies that did detect differences based on surgical subspecialty, one was a database study (NSQIP) comparing anterior lumbar interbody fusions (ALIFs) and lateral lumbar interbody fusion, which found lower readmission rates among neurosurgeons for multilevel procedures (3.9% vs .…”

“…Twelve studies reported on reoperation rates with 77–11,21,24 finding, no differences between groups 3,4,8–12,19–23. Two NSQIP database studies found lower rates of returning to the operating room if the surgeon was a neurosurgeon, irrespective of procedure type: ALIF/lateral lumbar interbody fusion (single-level: 2.1% vs .…”