268 - A Comparison of Peri-operative Outcomes of Anterior Cervical Decompres...

#268 A Comparison of Peri-operative Outcomes of Anterior Cervical Decompression and Fusion between Orthopaedic Surgeons and Neurosurgeons

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Noureldin (1)
K. Singh (1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Several studies have examined the influence of training specialty (orthopaedic surgery versus neurosurgery) on the surgical management of the spine. Most of these studies have focused on treatment algorithms and surgical techniques between spine surgeons, but few have compared surgical outcomes between these two surgical specialties. The purpose of this study was to analyze the peri-operative outcomes, complication rates, and mortality after an anterior cervical decompression and fusion (ACDF) based upon the surgeon's specialty (orthopaedic surgeons vs neurosurgeons).

Methods: The National Surgical Quality Improvement Program (NSQIP) database, developed and maintained by the American College of Surgeons (ACS), was queried for the years 2006-2011. Patients who underwent an ACDF were identified and divided into cohorts based upon the specialty of the primary surgeon (orthopaedic surgery and neurosurgery). Only elective procedures for degenerative spine diagnoses were included. Preoperative patient characteristics (demographics, comorbidities, preoperative lab values), surgery and hospital outcomes (e.g., operative time, length of stay), 30-day complication rates, and mortality were compared between groups. SPSS v.20 was utilized for statistical analysis with independent t-tests and χ2-tests for continuous and categorical variables respectively. A p-value ≤ 0.05 denoted statistical significance.

Results: A total of 6,495 ACDF procedures were identified from 2006-2011, of which 1,894 (29.2%) were performed by Orthopaedic surgeons and 4,601 (70.8%) by Neurosurgeons. The Neurosurgery cohort demonstrated a greater comorbidity burden from diabetes, paralysis and steroid use (p< 0.05) than the Orthopaedic cohort. Intraoperative data demonstrated that the ACDFs performed by Neurosurgeons were significantly longer (133.0 vs 119.0 minutes, p< 0.05) and had a higher rate of resident involvement (29.9 vs 26.1, p< 0.05). However, patients from the Orthopaedic cohort demonstrated a longer hospital stay and incurred a greater incidence of postoperative re-intubation, prolonged mechanical ventilation >48hrs and cardiac events when compared to the Neurosurgery cohort (p< 0.05). Despite these findings, the incidence of mortality between the surgical cohorts did not demonstrate a significant difference.

Conclusion: Patients who underwent an ACDF by a Neurosurgeon demonstrated a greater comorbidity burden and incurred a longer operative time than the Orthopaedic patients. However, the Orthopaedic patients incurred a greater incidence of postoperative airway related complications and cardiac events, which likely contributed to the longer LOS demonstrated in this surgical cohort. In light of these findings, further research is warranted to better characterize the factors associated with a greater incidence of postoperative complications among Orthopaedic patients.