The value-added benefit of utilizing two attending surgeons for patients with scoliosis secondary to cerebral palsy



The use of two attending surgeons during posterior spinal fusion (PSF) for cerebral palsy (CP) patients has been shown to improve perioperative outcomes. This study aims to determine if the use of two surgeons is associated with an increase in the number of subsequent surgeries that can be performed in the same operating room (OR) during business hours.


Patients with scoliosis and CP treated with PSF with minimum 90-day follow-up were included. Patients were grouped based on whether one or two attending surgeons performed the case. The primary outcome was the number of surgeries that followed in the same OR before 5 PM. Secondary outcomes included operative time, estimated blood loss (EBL), length of stay, rate of surgical site infection, and rate of unplanned return to the operating room.


Thirty-six patients were included (10 with 1 surgeon and 26 with 2 surgeons). The two surgeon group had a significant increase in the average number of surgeries subsequently performed in the same OR during business hours (1.1 vs. 0.3, p = 0.01), as well as shorter mean operative time (159 vs. 307 min, p = 0.007) and EBL (554 vs. 840 cc, p = 0.01; 26 vs. 39%EBV, p = 0.03).


The use of two attending surgeons was associated with a significant increase in the number of cases subsequently performed in the same OR during business hours, and significant decreases in operative time and EBL. Hospitals should consider the patient care and potential system-level improvements when considering implementation of two surgeon teams for PSF in CP patients.

Level of evidence

Therapeutic Level III.

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Fig. 1

Data availability

The data that support the findings of this study are available from the corresponding author, TCM, upon reasonable request.


  1. 1.

    Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B (2008) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39:214–223

    Article  Google Scholar 

  2. 2.

    Hägglund G, Pettersson K, Czuba T, Persson-Bunke M, Rodby-Bousquet E (2018) Incidence of scoliosis in cerebral palsy: a population-based study of 962 young individuals. Acta Orthop 89:443–447

    PubMed  PubMed Central  Article  Google Scholar 

  3. 3.

    Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351:1687–1692

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Persson-Bunke M, Hägglund G, Lauge-Pedersen H, Ma PW, Westbom L (2012) Scoliosis in a total population of children with cerebral palsy. Spine 37:E708–E713

    PubMed  Article  Google Scholar 

  5. 5.

    Murphy NA, Firth S, Jorgensen T, Young PC (2006) Spinal surgery in children with idiopathic and neuromuscular scoliosis: what’s the difference? J Pediatr Orthop 26:216–220

    PubMed  Article  Google Scholar 

  6. 6.

    Sharma S, Wu C, Andersen T, Wang Y, Hansen ES, Bünger CE (2013) Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 22:1230–1249

    PubMed  Article  Google Scholar 

  7. 7.

    Edler A, Murray DJ, Forbes RB (2003) Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease: is there an increased risk? Paediatr Anaesth 13:818–822

    PubMed  Article  Google Scholar 

  8. 8.

    Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128

    CAS  PubMed  Google Scholar 

  9. 9.

    Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465

    PubMed  Article  Google Scholar 

  10. 10.

    Jia R, Li N, Xu BY, Zhang W, Gu XP, Ma ZL (2017) Incidence, influencing factors, and prognostic impact of intraoperative massive blood loss in adolescents with neuromuscular scoliosis: a STROBE-compliant retrospective observational analysis. Medicine 96:e6292

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Kwan MK, Chan CYW (2017) Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis. Spine J 17:224–229

    PubMed  Article  Google Scholar 

  12. 12.

    Halanski MA, Elfman CM, Cassidy JA, Hassan NE, Sund SA, Noonan KJ (2013) Comparing results of posterior spine fusion in patients with AIS: are two surgeons better than one? J Orthop 10:54–58

    PubMed  PubMed Central  Article  Google Scholar 

  13. 13.

    Shrader MW, Wood W, Falk M, Segal LS, Boan C, White G (2018) The effect of two attending surgeons on the outcomes of posterior spine fusion in children with cerebral palsy. Spine Deform 6:730–735

    PubMed  Article  Google Scholar 

  14. 14.

    Bosch L, Boan C, Falk M, White GR, Shrader MW (2017) The effect of two attending surgeons on patients with large-curve adolescent idiopathic scoliosis undergoing posterior spinal fusion. Spine Deform 5:392–395

    PubMed  Article  Google Scholar 

  15. 15.

    Sethi RK, Pong RP, Leveque JC, Dean TC, Olivar SJ, Rupp SM (2014) The Seattle spine team approach to adult deformity surgery: a systems-based approach to perioperative care and subsequent reduction in perioperative complication rates. Spine Deform 2:95–103

    PubMed  Article  Google Scholar 

  16. 16.

    Ames CP, Barry JJ, Keshavarzi S, Dede O, Weber MH, Deviren V (2013) Perioperative outcomes and complications of pedicle subtraction osteotomy in cases with single versus two attending surgeons. Spine Deform 1:51–58

    PubMed  Article  Google Scholar 

  17. 17.

    Centers for Disease Control and Prevention (2020) Surgical site infection (SSI) event. Accessed 8 May 2020

  18. 18.

    Chan CYW, Kwan MK (2016) Perioperative outcome in posterior spinal fusion for adolescent idiopathic scoliosis. Spine 41:E694–E699

    PubMed  Article  Google Scholar 

  19. 19.

    Bauer JM, Yanamadala V, Shah SA, Sethi RK (2019) Two surgeon approach for complex spine surgery: rationale, outcome, expectations, and the case for payment reform. J Am Acad Orthop Surg 27:e408–e413

    PubMed  Article  Google Scholar 

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Author information




TCM: study design, data acquisition, statistical analysis, data interpretation, writing—original draft preparation, and manuscript preparation. ALG: data acquisition, writing—reviewing and editing, manuscript preparation. JTB: study design, statistical analysis, data interpretation, and manuscript preparation. HS: study design, writing—reviewing and editing, manuscript preparation. WHR: statistical analysis, data interpretation, and manuscript preparation. PBW: study design, data interpretation, writing—reviewing and editing, manuscript preparation. All authors: made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; drafted the work or revised it critically for important intellectual content; approved the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Tyler C. McDonald.

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Conflict of interest

Dr. Brooks is a paid consultant for DePuy, and is a paid presenter or speaker for Medtronic. For the remaining authors, none were declared.

Ethical approval

This retrospective chart review study involving human participants was in accordance with 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of The University of Mississippi Medical Center approved this study.

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McDonald, T.C., Gnam, A.L., Brooks, J.T. et al. The value-added benefit of utilizing two attending surgeons for patients with scoliosis secondary to cerebral palsy. Spine Deform (2021).

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  • Neuromuscular scoliosis
  • Two attending surgeons
  • Dual attending surgeons
  • Cerebral palsy