Adult Scoliosis Deformity Surgery: Comparison of Outcomes Between One Versus Two Attending Surgeons.

dc.contributor.author

Gomez, Jaime A

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Lafage, Virginie

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Sciubba, Daniel M

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Bess, Shay

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Mundis, Gregory M

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Liabaud, Barthelemy

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Hanstein, Regina

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Shaffrey, Christopher

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Kelly, Michael

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Ames, Christopher

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Smith, Justin S

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Passias, Peter G

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Errico, Thomas

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Schwab, Frank

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International Spine Study Group

dc.date.accessioned

2023-07-09T21:25:15Z

dc.date.available

2023-07-09T21:25:15Z

dc.date.issued

2017-07

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2023-07-09T21:25:15Z

dc.description.abstract

Study design

Retrospective review of prospectively collected data.

Objective

Assess outcomes of adult spinal deformity (ASD) surgery performed by one versus two attending surgeons.

Summary of background data

ASD centers have developed two attending teams to improve efficiency; their effects on complications and outcomes have not been reported.

Methods

Patients with ASD with five or more levels fused and more than 2-year follow-up were included. Estimated blood loss (EBL), length of stay (LOS), operating room (OR) time, complications, quality of life (Health Related Quality of Life), and x-rays were analyzed. Outcomes were compared between one-surgeon (1S) and two-surgeon (2S) centers. A deformity-matched cohort was analyzed.

Results

A total of 188 patients in 1S and 77 in 2S group were included. 2S group patients were older and had worse deformity based on the Scoliosis Research Society-Schwab classification (P < 0.05). There were no significant differences in levels fused (P = 0.57), LOS (8.7 vs 8.9 days), OR time (445.9 vs 453.2 min), or EBL (2008 vs 1898 cm; P > 0.05). 2S patients had more three-column osteotomies (3CO; P < 0.001) and used less bone morphogenetic protein 2 (BMP-2; 79.9% vs 15.6%; P < 0.001). The 2S group had fewer intraoperative complications (1.3% vs 11.1%; P = 0.006). Postoperative (6 wk to 2 yr) complications were more frequent in the 2S group (4.8% vs 15.6%; P < 0.002). After matching for deformity, there were no differences in (9.1 vs 10.1 days), OR time (467.8 vs 508.4 min), or EBL (3045 vs 2247 cm; P = 0.217). 2S group used less BMP-2 (20.6% vs 84.8%; P < 0.001), had fewer intraoperative complications (P = 0.015) but postoperative complications due to instrumentation failure/pseudarthrosis were more frequent (P < 0.01).

Conclusion

No significant differences were found in LOS, OR time, or EBL between the 1S and 2S groups, even when matching for severity of deformity. 2S group had less BMP-2 use, fewer intraoperative complications but more postoperative complications.

Level of evidence

2.
dc.identifier

00007632-201707010-00010

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28383

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

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10.1097/brs.0000000000002071

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International Spine Study Group

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Humans

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Scoliosis

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Treatment Outcome

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Length of Stay

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Retrospective Studies

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Follow-Up Studies

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Prospective Studies

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Adult

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Middle Aged

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Medical Staff, Hospital

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Patient Care Team

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Female

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Male

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Operative Time

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Surgeons

dc.title

Adult Scoliosis Deformity Surgery: Comparison of Outcomes Between One Versus Two Attending Surgeons.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

duke.contributor.orcid

Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226

pubs.begin-page

992

pubs.end-page

998

pubs.issue

13

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Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

42

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