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- Title
Comparing results of posterior spine fusion in patients with AIS: Are two surgeons better than one?
- Authors
Halanski, Matthew A.; Elfman, Corey M.; Cassidy, Jeffrey A.; Hassan, Nabil E.; Sund, Sarah A.; Noonan, Kenneth J.
- Abstract
Aims: Spinal deformity surgery is one of the most complicated procedures performed in pediatric orthopedics. These surgeries can account for long operative times and blood losses. Finding ways to limit patient morbidity undergoing these procedures may benefit many. We hypothesized that utilizing two fellowship trained pediatric spinal deformity surgeons would lead to decreased operative time and blood loss when compared with single surgeon. We felt very little difference would be found in terms of curve correction. Methods: A retrospective review of spinal deformity surgeries performed at two institutions was performed. At one institution, the standard of care was to have two fellowship deformity trained surgeons perform all deformity surgeries simultaneously, while at the second institution posterior spinal fusions performed by individual surgeons were performed. The single surgeon cohort was further divided based on instrumentation type (pedicle screw vs hybrid constructs). Cases for this review were limited to posterior spinal fusions without osteotomies in patients with idiopathic or idiopathic like curves. Cohorts were compared pre-operatively for age at surgery, sex, BMI, largest Cobb angle. Intraoperative comparisons included total EBL, instrumentation type screws vs hybrid, levels fused, and operative time. Comparisons between largest remaining Cobb, EBL/level, time/ level, lowest recorded Hb, allogenic transfusion requirements, length of PICU stay, and total length of hospital stay were then made. Pair-wise student t-tests was performed between cohorts with significance defined as a p-value of 0.05 or less. Conclusions: Twenty-four patients were found in the (BMP) cohort, where as eighty-two were found in the control group. No significant difference in age, sex, starting hemoglobin, BMI*, or maximum pre-operative Cobb between cohorts was found. A significantly lower number of levels were fused in the BMP cohort than the control (9 ± 2 vs 11 ± 2) p < 0.001, and likewise a significantly shorter operative time (average >2 h) was seen in the BMP cohort. Interestingly, no difference in estimated blood loss, blood loss/level fused, operative time/level fused was observed, yet a significantly greater drop in hemoglobin (average 1 g) p = 0.001 and allogenic transfusion rate was seen in the control group (4% (1/ 24) vs 29% (24/82)) p = 0.01. A greater improvement in Cobb angle was seen in the BMP group 46 ± 8 vs 35 ± 10° p < 0.001. No differences were seen in nights in the PICU and peri-operative complications, however patients in the BMP averaged nearly 1day less in the hospital than in the control group.
- Subjects
ACADEMIC medical centers; AGE distribution; BLOOD transfusion; BONE screws; DISEASES; HEMOGLOBINS; LENGTH of stay in hospitals; PROBABILITY theory; SEX distribution; SPINAL fusion; SURGEONS; T-test (Statistics); TIME; BODY mass index; RETROSPECTIVE studies; BLOOD loss estimation; ADOLESCENT idiopathic scoliosis; DESCRIPTIVE statistics; SPINAL curvatures
- Publication
Journal of Orthopaedics, 2013, Vol 10, Issue 2, p54
- ISSN
2589-9082
- Publication type
Article
- DOI
10.1016/j.jor.2013.03.001