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Spine (Phila Pa 1976). 2019 Feb 1;44(3):163-168. doi: 10.1097/BRS.0000000000002780.

Assessing Variability in In-Hospital Complication Rates Between Surgical Services for Patients Undergoing Posterior Cervical Decompression and Fusion.

Author information

1
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY.
2
Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY.
3
Department of Neurosurgery, Mount Sinai Hospital, New York, NY.
4
Department of Orthopedics, Mount Sinai Hospital, New York, NY.

Abstract

STUDY DESIGN:

A retrospective study was performed including all patients who underwent posterior cervical decompression and fusion (PCDF) by an orthopedic or neurological surgeon at a single institution between January 1, 2006 and November 30, 2016, and all patients who underwent PCDF by a spine surgeon in the National Surgical Quality Improvement Project database between 2007 and 2015. In-hospital complications were compared between surgical specialties.

OBJECTIVE:

The goal of this study was to determine if in-hospital complication rates differ significantly between surgical services for PCDF patients.

SUMMARY OF BACKGROUND DATA:

Orthopedic and neurological surgeons commonly perform PCDF, and differences in surgical opinion and management have been cited between these two specialties in recent literature. This represents a variable that should be evaluated.

METHODS:

Cases were preliminarily identified by CPT code and confirmed using the ICD-9 code 81.03 or ICD-10 code M43.22. Cases were separated based on if the primary surgeon was an orthopedic surgeon or a neurological surgeon. The primary outcome variable was in-hospital complication rates; cohorts were compared using bivariate and multivariate analysis.

RESULTS:

A total of 1221 patients at a single institution and 11,116 patients within the National Surgical Quality Improvement Project database underwent PCDF. Patients in the orthopedic surgery service had a higher proportion of bleeding requiring transfusion in both the institutional sample (14.5% vs. 9.08%, P = 0.003) and national sample (11.16% vs. 6.18%, P < 0.0001). In the national sample, orthopedic surgeons were 1.66 times as likely to encounter an in-hospital complication than neurological surgeons (95% CI: 1.44-1.91, P < 0.0001).

CONCLUSION:

When examining a large institutional sample and an even larger national sample, this study found that orthopedic surgeons were more likely to encounter perioperative bleeding requiring transfusion than neurological surgeons. When in-hospital complications were considered as a whole, in the national sample, orthopedic surgeons are more likely to encounter in-hospital complications than neurological surgeons when performing PCDF.

LEVEL OF EVIDENCE:

3.

PMID:
30005039
DOI:
10.1097/BRS.0000000000002780
[Indexed for MEDLINE]

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