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Okubo T, Nagoshi N, Kono H, Kobayashi Y, Tsuji O, Aoyama R, Isogai N, Ishihara S, Takeda K, Ozaki M, Suzuki S, Matsumoto M, Nakamura M, Watanabe K, Ishii K, Yamane J. Comparison of Surgical Outcomes After Posterior Decompression by Junior or Senior Surgeons for Patients With Cervical Ossification of the Posterior Longitudinal Ligament: Results From Retrospective Multicenter Cohort Study. Global Spine J 2024:21925682241260725. [PMID: 38831702 DOI: 10.1177/21925682241260725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To investigate surgical outcomes following posterior decompression for cervical ossification of the posterior longitudinal ligament (OPLL) when performed by board-certified spine (BCS) or non-BCS (NBCS) surgeons. METHODS We included 203 patients with cervical OPLL who were followed for a minimum of 1 year after surgery. Demographic information, medical history, and imaging findings were collected. Clinical outcomes were assessed preoperatively and at the final follow-up using the Japanese Orthopedic Association (JOA) score and the visual analog scale (VAS) for the neck. We compared outcomes between BCS surgeons, who must meet several requirements, including experience in more than 300 spinal surgeries, and NBCS surgeons. RESULTS BCS surgeons performed 124 out of 203 cases, while NBCS surgeons were primary in 79 cases, with 73.4% were directly supervised by a BCS surgeon. There was no statistically significant difference in surgical duration, estimated blood loss, and perioperative complication rates between the BCS and NBCS groups. Moreover, no statistically significant group differences were observed in each position of the C2-7 angle and cervical range of motion at preoperation and the final follow-up. Preoperative and final follow-up JOA scores, VAS for the neck, and JOA score recovery rate were comparable between the two groups. CONCLUSIONS Surgical outcomes, including functional recovery, complication rates, and cervical dynamics, were comparable between the BCS and NBCS groups. Consequently, posterior decompression for cervical OPLL is considered safe and effective when conducted by junior surgeons who have undergone training and supervision by experienced spine surgeons.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Hitoshi Kono
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Tatebayashi, Japan
| | - Yoshiomi Kobayashi
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopedic Surgery, Japan Red Cross Shizuoka Hospital, Shizuoka, Japan
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopedic Surgery, Saitama Medical Center, Saitama, Japan
| | - Ryoma Aoyama
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopedic Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Norihiro Isogai
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Shinichi Ishihara
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Spine and Spinal Cord Center, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
- Department of Orthopedic Surgery, Subaru Health Insurance Society Ota Memorial Hospital, Ota, Japan
| | - Kazuki Takeda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Keio Spine Research Group (KSRG), Tokyo, Japan
- New Spine Clinic Tokyo, Tokyo, Japan
| | - Junichi Yamane
- Keio Spine Research Group (KSRG), Tokyo, Japan
- Department of Orthopedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan
- Department of Orthopedic Surgery, Kanagawa Prefectural Police Association Keiyu Hospital, Yokohama, Japan
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Khajeh E, Fakour S, Ünal UK, Sabetkish N, Leins J, Ramouz A, Mieth M, Sabagh M, Abbasi Dezfouli S, Golriz M, Büchler MW, Mehrabi A. Assessing textbook outcomes following major liver surgery in association with obesity at a referral academic center. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107080. [PMID: 37738873 DOI: 10.1016/j.ejso.2023.107080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/13/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Outcomes of major surgeries in tertiary educational hospitals have been complicated by the referral of high-risk patients and the participation of trainees in surgical procedures. We analyzed outcomes of major hepatectomies in a tertiary academic setting emphasizing the role of training and obesity on textbook outcomes (TO). MATERIALS AND METHODS 971 adult patients who underwent open major hepatectomy (Mesohepatectomy [n = 111], hemihepatectomy [n = 610], and extended hepatectomy [n = 250]) were evaluated. A TO was defined as: a negative resection margin, no grade B/C bile leak, no major complications, no in-hospital mortality, and no 30-day readmission. TOs were compared following operations performed by senior surgeons and those performed by junior surgeons under the supervision of senior surgeons and between patients with and without obesity. RESULTS TO was achieved in 70.1% of patients overall (78.4% in mesohepatectomy, 73.1% in hemihepatectomy, and 59.2% in extended hepatectomy). The rate of TO was similar following operations performed by and supervised by a senior surgeon (69.3% vs 71.0%, p = 0.570). The rate of TO was significantly lower in patients with obesity (41.5% vs 74.6%, p < 0.001). Factors including increased age (odds ratio [OR] for 10-year increase = 0.83, 95% confidence interval [CI]: 0.73-0.96, p = 0.009), obesity (OR = 0.25, 95%CI: 0.16-0.37, p < 0.001), biliodigestive anastomosis (OR = 0.27, 95%CI: 0.19-0.40, p < 0.001), and portal vein resection (OR = 0.49, 95%CI: 0.28-0.87, p = 0.014) lower the rate of TO. CONCLUSION Promising outcomes are possible after major hepatectomy in an academic setting. Obese patients and those undergoing more complex surgeries had a higher risk of poor postoperative outcomes.
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Affiliation(s)
- Elias Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Sanam Fakour
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Umut Kaan Ünal
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Nastaran Sabetkish
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Johannes Leins
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Ali Ramouz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Markus Mieth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Mohammadsadegh Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Sepehr Abbasi Dezfouli
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Mohammad Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Markus W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany; Liver Cancer Center Heidelberg (LCCH), Heidelberg, Germany.
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Lin JD, Schupper AJ, Matthew J, Lee N, Osorio JA, Marciano G, Lombardi JM, Sardar Z, Lehman RA, Lenke LG. A New Objective Radiographic Criteria for Diagnosis of Adult Idiopathic Scoliosis: Apical Pedicle Diameter Asymmetry. World Neurosurg 2023; 178:e141-e146. [PMID: 37437804 DOI: 10.1016/j.wneu.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE We sought to test the hypothesis that a difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at the apex of a lumbar curve is a sensitive and/or specific criteria for adult idiopathic scoliosis (AdIS). METHODS Thirty-nine operative patients with adult deformity and lumbar major curves were identified. A chart review was performed. Radiographic measurements included lumbar Cobb, curve apex, and Cobb levels involved. Apical pedicle diameter at the concavity and convexity of the curve apex were measured. RESULTS Among these 39 patients, the average Cobb angle was 48.3 degrees. Curve apex averaged at L1/2 (range L1-L3). The curves spanned 4.7 levels (range 3-7). Twenty-five curves had the apex to the left, while 14 had the apex to the right. The average pedicle diameter at the apex was 6.1 mm. Fourteen patients had apical pedicle diameter asymmetry (APDA) >1 mm. Most (7 of 8, or 87.5%) of the patients with a history of adult idiopathic scoliosis had APDA >1 mm. A minority (7 of 31, 22.5%) of patients without known history of adult idiopathic scoliosis had APDA >1 mm (P < 0.01). CONCLUSIONS Apical pedicle diameter asymmetry is among the sensitive diagnostic criteria for AdIS and may be useful for differentiating lumbar major AdIS from degenerative lumbar scoliosis. The sensitivity of APDA >1 mm is 87.5%, with specificity of 77.4%. We propose a new, sensitive radiographic criterion for adult idiopathic scoliosis. A difference of ≥1 mm in pedicle diameter between the convex and concave pedicles at that apex of a lumbar curve has a sensitivity of 87.5% and specificity of 77.4% for patient-reported history of adolescent scoliosis. It can be a useful tool as exclusion criteria for studies on AdIS.
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Affiliation(s)
- James D Lin
- Department of Orthopedic Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Justin Matthew
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Nathan Lee
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph A Osorio
- Department of Neurosurgery, University of California, San Diego, School of Medicine, San Diego, California, USA
| | - Gerard Marciano
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Joseph M Lombardi
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Zeeshan Sardar
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Ronald A Lehman
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Lawrence G Lenke
- The Spine Hospital, New York-Presbyterian/Columbia University Medical Center, New York, New York, USA
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Karamian BA, Toci GR, Lambrechts MJ, Canseco JA, Basques B, Tran K, Alfonsi S, Rihn J, Kurd MF, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD, Kaye ID. Does Age Younger Than 65 Affect Clinical Outcomes in Medicare Patients Undergoing Lumbar Fusion? Clin Spine Surg 2022; 35:E714-E719. [PMID: 35700082 DOI: 10.1097/bsd.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/09/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To determine if age (younger than 65) and Medicare status affect patient outcomes following lumbar fusion. SUMMARY OF BACKGROUND DATA Medicare is a common spine surgery insurance provider, but most qualifying patients are older than age 65. There is a paucity of literature investigating clinical outcomes for Medicare patients under the age of 65. MATERIALS AND METHODS Patients 40 years and older who underwent lumbar fusion surgery between 2014 and 2019 were queried from electronic medical records. Patients with >2 levels fused, >3 levels decompressed, incomplete patient-reported outcome measures (PROMs), revision procedures, and tumor/infection diagnosis were excluded. Patients were placed into 4 groups based on Medicare status and age: no Medicare under 65 years (NM<65), no Medicare 65 years or older (NM≥65), yes Medicare under 65 (YM<65), and yes Medicare 65 years or older (YM≥65). T tests and χ 2 tests analyzed univariate comparisons depending on continuous or categorical type. Multivariate regression for ∆PROMs controlled for confounders. Alpha was set at 0.05. RESULTS Of the 1097 patients, 567 were NM<65 (51.7%), 133 were NM≥65 (12.1%), 42 were YM<65 (3.8%), and 355 were YM≥65 (32.4%). The YM<65 group had significantly worse preoperative Visual Analog Scale back ( P =0.01) and preoperative and postoperative Oswestry Disability Index (ODI), Short-Form 12 Mental Component Score (MCS-12), and Physical Component Score (PCS-12). However, on regression analysis, there were no significant differences in ∆PROMs for YM <65 compared with YM≥65, and NM<65. NM<65 (compared with YM<65) was an independent predictor of decreased improvement in ∆ODI following surgery (β=12.61, P =0.007); however, overall the ODI was still lower in the NM<65 compared with the YM<65. CONCLUSION Medicare patients younger than 65 years undergoing lumbar fusion had significantly worse preoperative and postoperative PROMs. The perioperative improvement in outcomes was similar between groups with the exception of ∆ODI, which demonstrated greater improvement in Medicare patients younger than 65 compared with non-Medicare patients younger than 65. LEVEL OF EVIDENCE Level III (treatment).
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Affiliation(s)
- Brian A Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Toci GR, Lambrechts MJ, Issa TZ, Karamian BA, Syal A, Parson JP, Canseco JA, Woods BI, Rihn JA, Hilibrand AS, Schroeder GD, Kepler CK, Vaccaro AR, Kaye ID. Does Age and Medicare Status Affect Clinical Outcomes in Patients Undergoing Anterior Cervical Discectomy and Fusion? World Neurosurg 2022; 166:e495-e503. [PMID: 35843583 DOI: 10.1016/j.wneu.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to determine if Medicare status and age affect clinical outcomes following anterior cervical discectomy and fusion. METHODS Patients who underwent cervical discectomy and fusion between 2014 and 2020 with complete preoperative and 1-year postoperative patient-reported outcome measures (PROMs) were grouped based on Medicare status and age: no Medicare under 65 years (NM < 65), Medicare under 65 years (M < 65), no Medicare 65 years or older (NM ≥ 65), and Medicare 65 years or older (M ≥ 65). Multivariate regression for ΔPROMs (Δ: postoperative minus preoperative) controlled for confounding differences between groups. Significant was set at P < 0.05. RESULTS A total of 1288 patients were included, with each group improving in the visual analog score (VAS) Neck (all, P < 0.001), VAS Arm (M < 65: P = 0.003; remaining groups: P < 0.001), and Neck Disability Index (M < 65: P = 0.009; remaining groups: P < 0.001) following surgery. Only M < 65 did not significantly improve in the Physical Component Score (PCS-12) and modified Japanese Orthopaedic Association (mJOA) score (P = 0.256 and P = 0.092, respectively). When comparing patients under 65 years, non-Medicare patients had better preoperative PCS-12 (P < 0.001), Neck Disability Index (P < 0.001), and modified Japanese Orthopaedic Association (P < 0.001), as well as better postoperative values for all PROMs (P < 0.001), but there were no differences in ΔPROMs. Multivariate analysis identified M < 65 to be an independent predictor of decreased improvement in ΔPCS-12 (β = -4.07, P = 0.015), ΔVAS Neck (β = 1.17, P = 0.010), and ΔVAS Arm (β = 1.15, P = 0.025) compared to NM < 65. CONCLUSIONS Regardless of age and Medicare status, all patients undergoing cervical discectomy and fusion had significant clinical improvement postoperatively. However, Medicare patients under age 65 have a smaller magnitude of improvement in PROMs.
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Affiliation(s)
- Gregory R Toci
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Mark J Lambrechts
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA.
| | - Tariq Z Issa
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Amit Syal
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Jory P Parson
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Jose A Canseco
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Barrett I Woods
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Jeffrey A Rihn
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Alan S Hilibrand
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Gregory D Schroeder
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Christopher K Kepler
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - Alexander R Vaccaro
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
| | - I David Kaye
- Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia Pennsylvania, USA
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Gullotti DM, Soltanianzadeh AH, Fujita S, Inserni M, Ruppel E, Franconi NG, Zygourakis C, Protopsaltis T, Lo SFL, Sciubba DM, Theodore N. Trends in Intraoperative Assessment of Spinal Alignment: A Survey of Spine Surgeons in the United States. Global Spine J 2022; 12:82S-86S. [PMID: 35393882 PMCID: PMC8998476 DOI: 10.1177/21925682211037273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Survey. OBJECTIVES To characterize national practices of and shortcomings surrounding intraoperative assessments of spinal alignment. METHODS Spine surgeons in the US were surveyed to analyze their experience with assessing spinal alignment intraoperatively. RESULTS 108 US spine surgeons from 77 surgical centers with an average of 19.2 + 8.8 years of surgical experience completed the survey. To assess alignment intraoperatively, 84% (91/108) use C-arm or spot radiographs, 40% (43/108) use full-length radiographs, and 20% utilize the T-bar (22/108). 88% of respondents' surgical centers (93/106) possessed a navigation camera and 63% of respondents (68/108) report using surgical navigation for 40% of their deformity cases on average. Reported deterrents for using current technology to assess alignment were workflow interruption (54%, 58/108), expense (33%, 36/108), and added radiation exposure (26%, 28/108). 87% of respondents (82/94) reported a need for improvement in current capabilities of making intraoperative assessments of spinal alignment. CONCLUSIONS Corrective surgery for spinal deformity is a complex procedure that requires a high level of expertise to perform safely. The majority of surveyed surgeons primarily rely on radiographs for intraoperative assessments of alignment. Despite the majority of surveyed surgical practices possessing navigation cameras, they are utilized only for a minority of spinal deformity cases. With the majority of surveyed surgeons reporting a need for improvement in technology to assess spinal alignment intraoperatively, 3 of the top design considerations should include workflow interruption, expense, and radiation exposure.
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Affiliation(s)
- David M. Gullotti
- Spine Align, LLC, Baltimore, MD, USA
- Division of Vascular and Interventional Radiology, Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | - Corinna Zygourakis
- Spine Align, LLC, Baltimore, MD, USA
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Themistocles Protopsaltis
- Spine Align, LLC, Baltimore, MD, USA
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Sheng-Fu Larry Lo
- Spine Align, LLC, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M. Sciubba
- Spine Align, LLC, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Spine Align, LLC, Baltimore, MD, USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Impact of Surgeon Experience on Outcomes of Anterior Cervical Discectomy and Fusion. J Am Acad Orthop Surg 2022; 30:e537-e546. [PMID: 34979519 DOI: 10.5435/jaaos-d-21-01080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/15/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The relationship between surgeon experience and cervical fusion outcomes has yet to be assessed. We investigate perioperative characteristics, patient-reported outcomes (PROMs), and minimal clinically important difference (MCID) achievement after anterior cervical diskectomy and fusion (ACDF) by the volume of cases done throughout an orthopaedic spine surgeon's career. METHODS ACDF procedures between 2005 and 2020 were identified. Group I included the first half of ACDF cases (#1-#321). PROMs were introduced in the second half of the ACDF cases; thus, the next 322 cases were subdivided to compare PROM and MCID between subgroups (cases #322 to #483 = group II and #484 to #645 = group III). PROMs, including VAS back/leg, Oswestry Disability Index (ODI), Short Form-12 Physical Composite Score, and PROMIS-PF, were collected preoperatively/postoperatively. Demographics, perioperative variables, mean PROMs, and MCID achievement were compared between groups and subgroups using the Student t-test and chi-square. Logistic regression evaluated MCID achievement using the established threshold values. RESULTS A total of 642 patients were included (320 in group I, 161 in group II, and 161 in group III). The latter cases had significantly decreased surgical time, blood loss, and postoperative length of stay in comparison of groups and subgroups (P ≤ 0.002, all). CT-confirmed 1-year arthrodesis rates were increased among the latter cases (P = 0.045). Group II had significantly higher arthrodesis rates than group III (P = 0.039). The postoperative complication rates were lower in the latter cases (P < 0.001, all), whereas subgroup analysis revealed lower incidence of urinary retention and other complications in group III (P ≤ 0.031, all). Mean PROMs were significantly inferior in group II versus group III for VAS neck at 6 months (P = 0.030), Neck Disability Index at 6 months preoperatively (P ≤ 0.022, both), Short Form-12 Physical Composite Score at 12 weeks/2 years (P ≤ 0.047, both), and PROMIS-PF at 12 weeks/6 months (P ≤ 0.036, both). The MCID attainment rates were higher among group III for VAS neck/Neck Disability Index at 2 years (P ≤ 0.005) and overall achievement across all PROMs (P ≤ 0.015, all). DISCUSSION Increased ACDF case volume may lead to markedly decreased surgical time, blood loss, and length of postoperative stay as well as improved clinical outcomes in pain, disability, and physical function.
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