387 - Comparison of Peri-operative Outcomes for Lumbar Decompression: Orthop...

#387 Comparison of Peri-operative Outcomes for Lumbar Decompression: Orthopaedic Surgery Versus 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. Noureldin (1)
K. Singh (1)

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

Abstract

Introduction: Very few studies have examined the influence of the training specialty (Orthopaedic surgery versus Neurosurgery) on the surgical management of the spine. The purpose of this study was to analyze the peri-operative outcomes, complication rates and mortality associated with a lumbar decompression (LD) based upon the primary surgeon's specialty (Orthopaedic surgery or Neurosurgery).

Methods: The National Surgical Quality Improvement Program (NSQIP) database was searched to identify patients undergoing a LD between 2006 and 2011. Only non-emergent cases for degenerative diagnoses were included. Patients with trauma, tumor, infection, or deformity were excluded. The selected cohort was divided based upon the primary surgeon´s specialty (Orthopaedic surgery or Neurosurgery). Preoperative patient characteristics, intraoperative parameters, hospital length of stay (LOS), 30-day complication rates, and mortality were compared between the two groups. Statistical analysis was performed with SPSS v.20 utilizing independent T-tests and χ2-tests for continuous and categorical variables, respectively. A p-value <0.05 denoted statistical significance.

Results: A total of 14,701 LDs were identified from 2006-2011, of which 4,641 (31.6%) were done by Orthopaedic surgeons and 10,060 (68.4%) by Neurosurgeons. There were no significant differences in the demographic characteristic between the two cohorts. A history of smoking, peripheral vascular disease, history of a cerebrovascular accident and chronic steroid use were more prevalent among Neurosurgery patients. Meanwhile, a history of paralysis and a recent operation (< 30 days) were more prevalent among Orthopaedic patients. The Neurosurgery cohort demonstrated greater ASA scores (Class 3-4) and longer operative times (115.2 vs 107.6 minutes, p< 0.05). However, the Orthopaedic patients demonstrated a greater number of intraoperative blood transfusions and incurred and longer hospital stay (p< 0.05). In addition, the Orthopaedic surgery patients demonstrated a greater incidence of postoperative blood transfusions, pneumonia, re-intubation, prolonged mechanical ventilation (>48 hours), urinary tract infections and peripheral nerve injury. The Neurosurgery patients demonstrated an increased incidence of postoperative organ space infection. Finally the mortality rate did not significantly differ between the surgical cohorts.

Conclusions: Neurosurgery patients demonstrated higher ASA scores and incurred longer operative times. However, it was the Orthopaedic patients who demonstrated a longer hospital stay and incurred a greater number of intraoperative blood transfusions and postoperative complications. Despite these differences, the incidence of mortality did not significantly differ between the groups. Further research is warranted to better characterize each specialty's patient comorbidity profile and determine its impact on the surgical outcomes and hospital resource utilization following a LD procedure.

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