Anterior Lumbar Fusion: Differences in Patient Selection and Surgical Outcomes Between Neurosurgeons and Orthopaedic Surgeons

World Neurosurg. 2018 Dec:120:e221-e226. doi: 10.1016/j.wneu.2018.08.034. Epub 2018 Aug 16.

Abstract

Objective: Anterior lumbar fusion (ALF) is performed by both neurosurgeons and orthopaedic surgeons. The aim of this study was to determine differences between the 2 surgical subspecialties in terms of patient selection and postoperative outcomes after ALF.

Methods: A retrospective cohort study of adult patients undergoing ALF in the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2014 was performed. Univariate analyses were performed to identify differences in baseline patient demographics, comorbidities, operative characteristics, and 30-day postoperative outcomes between neurosurgery and orthopaedic surgery patients. Multivariate logistic regression analysis was used to determine whether surgical subspecialty was an independent risk factor for postoperative complications.

Results: The study included 3182 patients, with 1629 (51.2%) neurosurgery patients and 1553 (48.8%) orthopaedic surgery patients. A greater proportion of neurosurgery patients were >65 years old, were being treated with preoperative steroids, had cardiac or pulmonary comorbidities, and had an American Society of Anesthesiologists classification III or higher. ALF procedures performed by neurosurgeons more frequently involved use of intervertebral devices and bone graft. On multivariate logistic regression analysis, ALF procedures performed by neurosurgeons were independently associated with a higher risk of reoperation (odds ratio = 1.61; 95% confidence interval, 1.02-2.56; P = 0.042) and urinary tract infection (odds ratio = 1.94; 95% confidence interval, 1.02-3.68; P = 0.043).

Conclusions: In addition to differences in baseline patient demographics and comorbidities and operative characteristics, ALF performed by neurosurgeons had a higher risk of 30-day reoperation and urinary tract infection compared with ALF performed by orthopaedic surgeons.

Keywords: Anterior lumbar fusion; Complications; NSQIP; Neurosurgery; Orthopaedic surgery; Patient selection.

Publication types

  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Bone Transplantation / statistics & numerical data
  • Cohort Studies
  • Databases, Factual
  • Humans
  • Logistic Models
  • Lumbar Vertebrae / surgery*
  • Middle Aged
  • Multivariate Analysis
  • Neurosurgeons*
  • Odds Ratio
  • Orthopedic Surgeons*
  • Patient Selection*
  • Postoperative Complications / epidemiology
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Prostheses and Implants / statistics & numerical data
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Spinal Fusion / methods*
  • Treatment Outcome
  • Urinary Tract Infections / epidemiology

Substances

  • Adrenal Cortex Hormones