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Surgeon volume affects short- and long-term surgical outcomes in idiopathic scoliosis

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Abstract

Study design

Retrospective review of New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database.

Objective

To identify the differences in short- and long-term complications, following long-segment pediatric spinal fusion in idiopathic scoliosis surgery, between surgeons with low versus high annual surgical volume.

Summary of background data

Spinal deformity surgery is complex and requires significant training and repetition to master. Surgeon and hospital volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. However, there is limited literature regarding the impact of surgeon volume on long-term outcomes following pediatric idiopathic spinal deformity correction.

Methods

This is a retrospective review of the SPARCS inpatient database from 2004 to 2013 of pediatric patients who underwent idiopathic scoliosis surgery. Surgeons were stratified into high (> 15 cases/year)- and low (≤ 15 cases/year)-volume cohorts by aggregating all cases completed over the study period until 50% of the total cases were captured above and below an average case per-year threshold. This threshold occurred at 15 cases/year. Short-term and long-term readmission and medical/surgical complications were collected. Multivariate logistic regression models assessed the risk of short- and long-term complications between cohorts.

Results

3910 pediatric patients underwent a primary arthrodesis from a total of 223 surgeons. More high-volume surgeons operated at academic teaching hospitals (p < 0.001), used a combined AP surgical approach (p < 0.001), and fewer utilized rhBMP (p < 0.001). High-volume surgeons had shorter lengths of stay (p < 0.001). Low-volume surgeons had increased odds of inpatient surgical complications (OR 1.55, 95% CI 1.00–2.45). Low-volume surgeons had increased odds of revision at 5 and 10 years (5 years. OR 1.56, 95% CI 1.05–2.31; 10 years. OR 1.59, 95% CI 1.09–2.31). Low-volume surgeons had increased odds of implant malfunction at 10 years (OR 1.81, 95% CI 1.15–2.86).

Conclusions

High-volume surgeons had decreased odds of short- and long-term complications compared to low volume when performing primary spinal arthrodesis in idiopathic scoliosis. Low-volume surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long-term follow-up with a significantly increased risk of implant malfunction at 10 years post-operatively.

Level of evidence

Level III

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Funding

No funds were received in support of this work.

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Authors and Affiliations

  1. Billie and George Ross Center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery, Cohen’s Children Medical Center, Northwell Health System, 7 Vermont Drive, Lake Success, NY, 11042, USA

    Dean Perfetti, Aaron M. Atlas, Jesse Galina, Alexander Satin, Sayyida Hasan, Terry Amaral & Vishal Sarwahi

Authors
  1. Dean Perfetti
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  2. Aaron M. Atlas
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  3. Jesse Galina
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  4. Alexander Satin
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  5. Sayyida Hasan
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  6. Terry Amaral
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  7. Vishal Sarwahi
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Contributions

DP conceptualization, data curation, investigation, writing—review and editing, final approval. JG data curation, Investigation, writing—original draft, writing—review and editing, final approval. AA conceptualization, data curation, investigation, writing—original draft, Final approval. AS conceptualization, data curation, investigation, validation, writing—review and editing, final approval. SH investigation, supervision, final approval. TA conceptualization, project administration, supervision, final approval. VS conceptualization, investigation, project administration, supervision, writing—review and editing, final approval.

Corresponding author

Correspondence to Dean Perfetti.

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Conflict of interest

Outside of this work, Vishal Sarwahi consults for Medtronic and Precision Spine, and receives royalties from Precision Spine. None of the remaining authors have anything to declare.

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Perfetti, D., Atlas, A.M., Galina, J. et al. Surgeon volume affects short- and long-term surgical outcomes in idiopathic scoliosis. Spine Deform 8, 455–461 (2020). https://doi.org/10.1007/s43390-020-00058-9

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  • DOI: https://doi.org/10.1007/s43390-020-00058-9

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