388 - Comparison of Peri-operative Outcomes of Lumbar Fusion: Orthopaedic Su...

#388 Comparison of Peri-operative Outcomes of Lumbar Fusion: 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: The influence of the training specialty (Orthopaedic surgery versus Neurosurgery) on the outcomes associated with spine surgery is not well characterized. The purpose of this study was to compare the peri-operative outcomes, complication rates, and mortality of lumbar fusion (LF) procedures between Orthopaedic surgeons and Neurosurgeons.

Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients undergoing an elective LF for degenerative pathologies of the spine from 2006-2011. The selected cohort was divided based upon the primary surgeons specialty (Orthopaedic Surgery or Neurosurgery). Preoperative patient characteristics, intraoperative and hospital outcomes, 30-day complication rates, and mortality were compared between 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 determined statistical significance.

Results: A total of 7,909 LF were identified from 2006-2011, of which 3,887 (49.1%) were performed by Orthopaedic surgeons and 4,022 (50.9%) by Neurosurgeons. There were no differences in the age at the time of surgery or gender distribution between the surgical cohorts. However, the Neurosurgery cohort demonstrated a greater percentage of African-Americans (p< 0.05). Analysis of the preoperative comorbidities demonstrated that the Neurosurgery patients were more often smokers and admitted to consuming alcohol, while the patients in the Orthopaedic cohort were more likely to have undergone a recent operation (< 30 days) (p< 0.05). The Neurosurgery cohort demonstrated a greater percentage of ambulatory LF procedures and more frequent resident involvement (p< 0.05). In addition, these patients incurred a longer operative time and had a higher incidence of a postoperative stroke than those in the Orthopaedic cohort. In contrast Orthopaedic patients, who demonstrated a shorter operative time, incurred a longer hospital stay and a greater incidence of postoperative blood transfusions and peripheral nerve injuries (p< 0.05). There were no significant differences in mortality between groups.

Conclusions: The results in this study demonstrate distinct patient profiles and peri-operative events associated with each spine surgery specialty. Neurosurgery patients more often underwent a LF in an ambulatory setting and incurred a greater incidence of postoperative strokes. In contrast Orthopaedic patients demonstrated a longer hospital stay and incurred a greater incidence of postoperative blood transfusions and peripheral nerve injuries. Despite these differences, the mortality rate did not differ between the surgical cohorts. In light of these findings, further studies are warranted to better characterize the risk factors associated with each specialty and their impact in patient outcomes and hospital resource utilization after a LF procedure.

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