The Effect of Two Attending Surgeons on Patients With Large-Curve Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion

Abstract

A chart review was conducted on all eligible patients from 2009 to 2014. 47 patients were identified, 19 of whom had two attending surgeons while 28 underwent PSF performed by a single attending surgeon assisted by a resident or PA. All patients underwent similar operative procedures with pedicle-screw only constructs. Patients in the two groups underwent identical surgical and anesthetic protocols, including use of tranexemic acid. Percent EBL was calculated as EBL divided by total estimated blood volume, which was estimated as weight in kilograms multiplied by either 75ml/kg for males or 65ml/kg for females. All patients were followed out to a minimum of one year. The Student's T-test was used to compared the three major variables of blood loss, anesthesia time, and hospital length of stay. A Chi-Square test was used to compare categorical variables between the groups. AbstractBackground and Significance: Surgical correction of AIS carries a substantial risk of complication. The literature supports improved perioperative outcomes through the two surgeon strategy in other complex orthopedic procedures. Research Question: Does the presence of 2 versus 1 attending affect the perioperative morbidity of posterior spinal fusion (PSF) in patients with adolescent idiopathic scoliosis (AIS) curves greater than 70°. Methods: We reviewed the database from a large regional children's hospital of all patients with AIS curves greater than 70°who underwent PSF from 2009-2014 and divided the cohort into single versus 2-surgeon groups (28 vs. 19 cases, respectively). We analyzed cases for length of surgery, estimated blood loss, and length of stay. Results: The groups were identical when comparing age, gender, spinal levels fused, and average ASA score. However, the average Cobb angle in the single surgeon group was significantly less than in the 2 surgeon group at 78.4 vs 84.0 degrees, respectively (p=0.049). Mean operative time for single versus 2 surgeons was 238 vs 212 minutes (p=0.078). Mean percent estimated blood loss was 26% for single surgeon vs 31% for 2 surgeons (p=0.236), and mean estimated blood loss for single surgeon vs 2 surgeons was 830ml vs 1045ml (p=0.052). Mean length of stay was significantly decreased in the 2 surgeon group at 5.16 days versus the single surgeon group at 6.82 days (p=0.002). Conclusions:The use of 2 surgeons in AIS deformity correction at an experienced regional children's hospital had a variable effect on clinical outcomes; the mean length of stay was reduced in the twosurgeon group but there was no difference in operative time or blood loss. This study does not rule out the potential for positive impact with a two-surgeon strategy, and given previous supportive data in the literature, this approach should further evaluated to determine its effect on improving perioperative outcomes.

Single- versus dual-attending strategy for spinal deformity surgery: 2-year experience and systematic review of the literature

“…13,16,17 Five of 8 (62.5%) studies found that EBL was significantly lower in dual-attending cases, 3,13,[16][17][18] and 3 studies did not find a difference. 12,14,15 Six of 8 (75%) studies found that operative time was significantly reduced, 3,13,[15][16][17][18] and 2 studies did not find a difference. 12,14 Reporting of complications was handled very heterogeneously across included studies with regard to their definition and timing.…”

“…12,14,15 Six of 8 (75%) studies found that operative time was significantly reduced, 3,13,[15][16][17][18] and 2 studies did not find a difference. 12,14 Reporting of complications was handled very heterogeneously across included studies with regard to their definition and timing. Three studies found a lower need for PRBC transfusions in dualattending cases.…”

“…4) are listed in Table 4. 3,[12][13][14][15][16][17][18]21 Four were prospective and 5 were retrospective studies. Single-versus dual-attending strategies for adult deformity were reported on in 3 papers 3,14,21 and for pediatric patients with adolescent idiopathic scoliosis (AIS), neuromuscular, or other forms of scoliosis surgery were reported on in 6 papers.…”

“…Single-versus dual-attending strategies for adult deformity were reported on in 3 papers 3,14,21 and for pediatric patients with adolescent idiopathic scoliosis (AIS), neuromuscular, or other forms of scoliosis surgery were reported on in 6 papers. 12,13,[15][16][17][18] Three of the identified articles were derived from the same authors and institution, and there appeared to be some overlap in the reported data of those 3 articles. 13,16,17 Five of 8 (62.5%) studies found that EBL was significantly lower in dual-attending cases, 3,13,[16][17][18] and 3 studies did not find a difference.…”

“…11 More recently, a growing body of literature has included reports on dual-attending strategies for spinal deformity correction to improve patient safety. 3,[12][13][14][15][16][17][18] In an effort to optimize patient care while fostering collaboration between the neurosurgery and orthopedic departments, a neuro-ortho dual-attending collaboration was established at our institution for the evaluation, treatment, and follow-up of patients with challenging spinal conditions. Here we report our experience gained in the 2 years since the implementation of this strategy.…”