356 - A Comparison of Peri-operative Outcomes of Cervical Spine Surgery betw...

#356 A Comparison of Peri-operative Outcomes of Cervical Spine Surgery between Orthopaedic Surgery and Neurosurgery

Epidemiology/Natural History

Poster Presented by: K. Singh

Author(s):

A.J. Marquez-Lara (1)
S.V. Nandyala (1)
S.J. Fineberg (1)
M. Nouredin (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 surgical management of the spine. Most of these studies have focused on treatment algorithms and surgical techniques between specialties, but few have reported on the surgical outcomes between these two groups. The purpose of this study was to analyze the peri-operative outcomes, complication rates, and mortality after cervical spine surgery (CSS) based upon the surgeon's specialty (Orthopaedic surgeons vs nNeurosurgeons).

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 a CSS procedure 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 8,648 CSS procedures were identified from 2006-2011, of which 2,294 (26.5%) were performed by Orthopaedic surgeons and 6,354 (73.5%) by Neurosurgeons. The Neurosurgery cohort demonstrated patients with a greater incidence of paralysis and alcohol abuse (p< 0.05) than the Orthopaedic cohort. Intraoperative data demonstrated that the CSS procedures performed by Neurosurgeons were significantly longer (134.9 vs 128.1 minutes, p< 0.05) and had a higher frequency of resident involvement (32.1 vs 29.2, p< 0.05). However, patients from the Orthopaedic cohort demonstrated a longer hospital stay and incurred a greater incidence of postoperative deep wound infections, 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 a CSS procedure 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 number of postoperative airway related complications, wound infections and cardiac events. The increased incidence of postoperative complications in Orthopaedic patients 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.