Skip to main content

Advertisement

SpringerLink
Log in

The Effect of Two Attending Surgeons on the Outcomes of Posterior Spine Fusion in Children With Cerebral Palsy

  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Background

Posterior spinal fusion (PSF) in children with cerebral palsy (CP) carries a high risk of complications and morbidity. The purpose of this study is to investigate the impact of using two attending surgeons on blood loss, operative time, and complications in this fragile population.

Methods

This was a prospective, matched cohort analysis of patients with CP who underwent PSF with two attending surgeons. These were matched with a control group that had a single-surgeon team, assisted by a senior resident or PA. The groups were compared using paired Student t tests and chi-square tests.

Results

50 patients were included in the study (25 study and 25 matched controls), determined by our power analysis. There was no statistical difference in the mean age, preoperative major curve angle, major curve angle correction, or use of antifibrinolytics. The two-surgeon group decreased surgical time from 5.25 to 3.3 hours (p = .000002), and estimated blood loss from 1,238 to 865 mL (p = .009). The complication rate decreased from 33% to 8% (p=.034). Length of stay was also decreased from 6.5 days to 5.35 (p = .02).

Conclusions

Although confounding variables were present, this study demonstrates that the use of a two-surgeon team during spinal surgery for patients with cerebral palsy could have a role in reducing operative time, blood loss, complication rates, and hospital length of stay. Overall, these factors and any improved operating room efficiencies may lead to lasting improved patient outcomes.

Level of Evidence

Level III, retrospective, comparative study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. McCarthy J, D’Andrea LP, Betz RR, et al. Scoliosis in the child with cerebral palsy. J Am Acad Orthop Surg 2006;14:367–75.

    Article  Google Scholar 

  2. Tsirikos AI, Lipton G, Chang WN, et al. Surgical correction of scoliosis in pediatric patients with cerebral palsy using the unit rod instrumentation. Spine 2008;33:1133–40.

    Article  Google Scholar 

  3. Watanabe K, Lenke LG, Daubs MD, et al. Is spine deformity surgery in patients with spastic cerebral palsy truly beneficial? A patient/parent evaluation. Spine 2009;34:2222–32.

    Article  Google Scholar 

  4. Modi HN, Hong JY, Mehta SS, et al. Surgical correction and fusion using posterior-only pedicle screw construct for neuropathic scoliosis in patients with cerebral palsy: a three-year follow-up study. Spine 2009;34:1167–75.

    Article  Google Scholar 

  5. Mohamad F, Parent S, Pawelek J, et al. Perioperative complications after surgical correction in neuromuscular scoliosis. J Pediatr Orthop 2007;27:392–7.

    Article  Google Scholar 

  6. Sharma S, Wu C, Andersen T, et al. Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. Eur Spine J 2013;22:1230–49.

    Article  Google Scholar 

  7. Fang A, Hu SS, Endres N, et al. Risk factors for infection after spinal surgery. Spine 2005;30:1460–5.

    Article  Google Scholar 

  8. Simchen E, Stein H, Sacks TG, et al. Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients. J Hosp Infect 1984;5:137–46.

    Article  CAS  Google Scholar 

  9. Watanabe M, Sakai D, Matsuyama D, et al. Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation. J Neurosurg Spine 2010;12:540–6.

    Article  Google Scholar 

  10. Wimmer C, Gluch H, Franzreb M, et al. Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 1998;11:124–8.

    CAS  Google Scholar 

  11. Ames CP, Barry JJ, Keshavarzi S, et al. Perioperative outcomes and complications of pedicle subtraction osteotomy in cases with single versus two attending surgeons. Spine Deform 2013;1:51–8.

    Article  Google Scholar 

  12. Halanski MA, Elfman CM, Cassidy JA, et al. Comparing results of posterior spine fusion in patients with AIS: are two surgeons better than one? J Orthop 2013;10:54–8.

    Article  Google Scholar 

  13. Heffernan MJ, Seehausen DA, Andras LM, et al. Comparison of outcomes after posterior spinal fusion for adolescent idiopathic and neuromuscular scoliosis: does the surgical first assistant’s level of training matter? Spine 2014;39:648–55.

    Article  Google Scholar 

  14. Aloia TA, Zorzi D, Abdalla EK, et al. Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg 2005;242:172–7.

    Article  Google Scholar 

  15. Blam OG, Vaccaro AR, Vanichkachorn JS, et al. Risk factors for surgical site infection in the patient with spinal injury. Spine 2003;28:1475–80.

    PubMed  Google Scholar 

  16. Palavecino M, Kishi Y, Chun YS, et al. Two-surgeon technique of parenchymal transection contributes to reduced transfusion rate in patients undergoing major hepatectomy: analysis of 1,557 consecutive liver resections. Surgery 2010;147:40–8.

    Article  Google Scholar 

  17. Skinner A, Maoate K, Beasley S. Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times. J Laparoendosc Adv Surg Tech A 2010;20:383–5.

    Article  Google Scholar 

  18. Sink EL, Leunig M, Zaltz I, et al. Reliability of a complication classification system for orthopaedic surgery. Clin Orthop Relat Res 2012;470:2220–6.

    Article  Google Scholar 

  19. Bohtz C, Meyer-Heim A, Min K. Changes in health-related quality of life after spinal fusion and scoliosis correction in patients with cerebral palsy. J Pediatr Orthop 2011;31:668–78.

    Article  Google Scholar 

  20. Bosch L, Boan C, Falk M, et al. The effect of two attending surgeons on patients with large-curve adolescent idiopathic scoliosis undergoing posterior spinal fusion. Spine Deform 2017;5:392–5.

    Article  Google Scholar 

  21. Arriaga AF, Gawande AA, Raemer DB, et al. Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams. Ann Surg 2014;259:403–10.

    Article  Google Scholar 

  22. Beard JD, Marriot J, Purdie H, Crossley J. Assessing the surgical skills of trainees in the operating theatre: a prospective observational study of the methodology. Health Technol Assess 2011;15:i–xxi.

    Article  CAS  Google Scholar 

  23. Spanager L, Konge L, Dieckmann P, et al. Assessing trainee surgeons’ nontechnical skills: five cases are sufficient for reliable assessments. J Surg Educ 2015;72:16–22.

    Article  Google Scholar 

  24. Yule S, Flin R, Paterson-Brown S, et al. Development of a rating system for surgeons’ non-technical skills. Med Educ 2006;40:1098–104.

    Article  CAS  Google Scholar 

  25. Ludwig AT, Inampudi L, O’Donnell MA, et al. Two-surgeon versus single-surgeon radical cystectomy and urinary diversion: impact on patient outcomes and costs. Urology 2005;65:488–92.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nemours A.I. DuPont Hospital for Children, 1600 Rockland Road, 19803, Wilmington, DE, USA

    M. Wade Shrader MD

  2. Banner-University Medical Center, Orthopaedic Residency Program, 1111 E McDowell Rd, 85006, Phoenix, AZ, USA

    William Wood MD

  3. Phoenix Children’s Hospital, Center for Pediatric Orthopaedics, 1919 East Thomas Road, 85006, Phoenix, AZ, USA

    Miranda Falk PA-C, Lee S. Segal MD, Carla Boan MSc & Greg White MD

Authors
  1. M. Wade Shrader MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William Wood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Miranda Falk PA-C
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lee S. Segal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carla Boan MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Greg White MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Wade Shrader MD.

Additional information

Author disclosures: MWS (none), WW (none), MF (none), LSS (none), CB (none), GW (none).

IRB statement: This project was reviewed and approved by our institution’s IRB.

Financial disclosure: No financial support was provided for this study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shrader, M.W., Wood, W., Falk, M. et al. The Effect of Two Attending Surgeons on the Outcomes of Posterior Spine Fusion in Children With Cerebral Palsy. Spine Deform 6, 730–735 (2018). https://doi.org/10.1016/j.jspd.2018.03.002

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.jspd.2018.03.002

Keywords

Search

Navigation