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Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons

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Abstract

Study Design

Retrospective case series.

Objective

To assess the perioperative morbidity of pedicle subtraction osteotomy (PSO) based on the presence of 1 versus 2 attending surgeons.

Background Summary

Pedicle subtraction osteotomies are challenging cases with high complication rates and substantial physiological burden on patients. The literature supports the benefits of 2-surgeon strategies in complex cases in other specialties.

Methods

We reviewed a single institution database of all pedicle subtraction osteotomies (78 cases) from 2005–2010 and divided the cohort into single versus 2-surgeon groups (42 vs. 36 cases, respectively). We performed subset analysis after excluding cases before 2007 and excluding patients with staged anterior and posterior procedures.We analyzed cases for estimated blood loss, length of surgery, length of stay, radiographic analysis, rate of return to the operating room within 30 days, and medical and neurological complications.

Results

The groups were similar when comparing mean number of posterior levels fused, levels decompressed and revision rates, however, the average age of the single surgeon and 2 surgeon groups was 57.6 and 64.3 years, respectively (p =.02). The 2 groups had comparable correction of radiographic parameters. Mean percent estimated blood loss for single versus 2 surgeons was 109% versus 35% (p!.001) and estimated blood loss was 5,278 versus 2,003 mL (p <.001). Average surgical time for single versus 2 surgeons was 7.6 versus 5.0 hours (p <.001). A total of 45% of single-surgeon patients compared with 25% of 2-surgeon patients experienced at least 1 major complication within 30 days. In the single-surgeon group, 19% had unplanned surgery within 30 days, versus 8% in the 2-surgeon group.

Conclusions

The use of 2 surgeons at an experienced spine deformity center decreases the operative time and estimated blood loss, and may be a key factor in witnessed decreased major complication prevalence. This approach also may decrease the rate of premature case termination and return to operating room in 30 days.

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Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University of California, 505 Parnassus Avenue, RM M-779, Box 0112, San Francisco, CA, 94143-0112, USA

    Christopher P. Ames MD & Sassan Keshavarzi MD

  2. Department of Orthopaedic Surgery, University of California, 500 Parnassus Ave, MUW 314, Box 0728, San Francisco, CA, 94143-0112, USA

    Jeffrey J. Barry MD, Ozgur Dede MD, Michael H. Weber MD & Vedat Deviren MD

Authors
  1. Christopher P. Ames MD
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  2. Jeffrey J. Barry MD
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  3. Sassan Keshavarzi MD
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  4. Ozgur Dede MD
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  5. Michael H. Weber MD
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  6. Vedat Deviren MD
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Corresponding author

Correspondence to Christopher P. Ames MD.

Additional information

Author disclosures: CPA (consulting for DePuy, Medtronic, Stryker; employment by University of California—San Francisco; grant from Trans1; patents from Fish & Richardson, PC; royalties from AESCULAP, LAWX; stock options: Trans1, Doctors Research Group, Visulase all less than 1%); JJB (none); SK (none); OD (none); MHW (none); VD (honorarium and consulting for Stryker, NuVasive, Guidepoint, and Medtronic).

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Ames, C.P., Barry, J.J., Keshavarzi, S. et al. Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons. Spine Deform 1, 51–58 (2013). https://doi.org/10.1016/j.jspd.2012.10.004

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  • DOI: https://doi.org/10.1016/j.jspd.2012.10.004

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