Spine Surgical Subspecialty and Its Effect on Patient Outcomes – A Systematic Review and Meta-Analysis

Abstract

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.

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

“…Spinal surgery is considered a critical territory within both orthopedic and neurosurgical practices. Spinal surgeries are usually performed to diminish pain, reconstruct specific areas for better function, and correct deformities, to allow a better quality of life for patients affected by spinal disorders that impact the vertebral column and associated structures [ 24 , 25 , 26 ]. Studies outlining differences between the two specialties in the perioperative outcomes among spinal surgery patients have been presented in Table 1 .…”

“…This might result in longer operational times and reduced transfusion rates [ 65 ]. Many studies showed a cutdown in operative time blood loss intraoperative complications and hospital stays when surgeons of both specialties collaborate and attend the surgery [ 24 ]. There was no statistical difference in wound infection rates between spine surgeries performed by two specialties [ 66 ].…”

“…Percutaneous kyphoplasty (PKP) has become a widely acceptable surgical procedure to mitigate pain and halt the advancement of kyphotic deformity among patients of traumatic, osteoporotic, and metastatic compression fractures [ 22 , 23 ]. The two specialties, neurosurgery (NS) and orthopedic surgery (OS), both possess the surgical expertise and adeptness to manage and perform spinal procedures [ 24 ].…”

“…Some studies have invariably maintained that past surgical training has no consequence on perioperative complications, while other studies showed notable differences in complication rates and outcomes. Unfortunately, biased studies establishing the superiority of one specialty over the other have been disseminated undermining the significance of the collaboration of NS and OS [ 24 ]. A collaborative approach in training spine surgeons under the mentorship of both neurosurgeons and orthopedic surgeons is critical and will equip the trainees with multifaceted skills [ 44 ].…”

Surgeon Experience Matters: An Exact Matched Analysis of TLIF Outcomes Demonstrates No Difference in Surgical Outcomes Between Experienced Neurosurgeons and Orthopedic Surgeons

“…Any observed differences are likely attenuated with increasing surgeon experience. Lambrechts et al , 6 a large systematic review and meta-analysis, reported similar rates of readmission, complications, and reoperations between neurosurgeons and orthopedic surgeons across a wide variety of spine surgeries, although all the papers included failed to control for surgeon experience. To the authors knowledge, there have been no studies that specifically characterize TLIF outcomes between surgical specialties accounting for surgeon experience.…”