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European Spine Journal

, Volume 28, Issue 9, pp 2112–2121 | Cite as

The impact of anesthesia and surgical provider characteristics on outcomes after spine surgery

  • Lauren A. Wilson
  • Megan Fiasconaro
  • Jashvant Poeran
  • Jiabin Liu
  • Federico Girardi
  • Stavros G. MemtsoudisEmail author
Original Article

Abstract

Purpose

Information regarding the impact of provider characteristics on perioperative outcomes in the spine surgery setting is limited. Existing studies primarily consider the impact of surgical provider volume. This analysis sought to identify the impact of anesthesiologist and surgeon volume and experience as well as anesthesia care team composition on adverse outcomes following anterior cervical discectomy and fusions (ACDF) and posterior lumbar fusions (PLF).

Methods

We identified 5900 patients who underwent ACDF or PLF procedures at a high-volume orthopedic institution from 2005 to 2014. Provider characteristics of interest were anesthesiologist and surgeon volume and experience along with anesthesia care team composition. Multivariable logistic regression models were used to evaluate the outcomes of any complication, cardiopulmonary complication, and prolonged length of stay (> 7 days). Intraclass correlation coefficients were calculated to determine how much variation in outcomes could be explained by provider characteristics.

Results

There were no significant relationships between provider characteristics and perioperative outcomes among ACDF patients. Within the PLF cohort, surgeon annual case volume > 25 was associated with decreased odds of prolonged length of stay, while anesthesia resident involvement was associated with increased odds of prolonged length of stay. Surgeon characteristics explained the greatest proportion of variation in outcomes while anesthesiologist characteristics explained the least.

Conclusions

Anesthesia provider volume and experience did not significantly impact the odds of adverse outcome for ACDF and PLF patients. Higher surgeon volume was exclusively associated with decreased odds of prolonged length of stay following PLF. Further study is necessary to determine if these relationships persist in a less-specialized setting.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

Anesthesiologists Surgeons Case volume Anterior cervical discectomy and fusion Posterior lumbar fusion 

Notes

Compliance with ethical standards

Conflict of interest

Lauren A. Wilson, Megan Fiasconaro, Jashvant Poeran, Jiabin Liu, and Federico Girardi have no conflict of interest. Stavros G. Memtsoudis is a director on the boards of the American Society of Regional Anesthesia and Pain Medicine (ASRA) and the Society of Anesthesia and Sleep Medicine (SASM). He is a one-time consultant for Sandoz Inc. and Teikoku and the holder of US Patent ulticatheter Infusion System. US-2017-0361063. He is the owner of SGM Consulting, LLC and co-owner of FC Monmouth, LLC. None of the above relations influenced the conduct of the present study.

Supplementary material

586_2019_6055_MOESM1_ESM.pptx (143 kb)
Supplementary material 1 (PPTX 142 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Lauren A. Wilson
    • 1
  • Megan Fiasconaro
    • 1
  • Jashvant Poeran
    • 2
    • 3
  • Jiabin Liu
    • 1
  • Federico Girardi
    • 4
  • Stavros G. Memtsoudis
    • 1
    Email author
  1. 1.Department of Anesthesiology, Critical Care and Pain ManagementHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Department of OrthopedicsIcahn School of Medicine at Mount SinaiNew YorkUSA
  4. 4.Spine Surgery Service, Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA

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