Thirty-Day Perioperative Outcomes in Spinal Fusion by Specialty
within the NSQIP Database
McCutcheon BA, Ciacci JD, Marcus LP, Noorbakhsh A, Gonda DD, McCafferty R, Taylor W,
Chen CC, Carter BS, Chang DC
Spine. 2015;40:1122-1131. PubMed ID: 25202939. Available at: http://www.ncbi.nlm.nih.gov/
Study Design. Cross-sectional analysis of the American College of Surgeons’ National
Surgical Quality Improvement Program database between 2005 and 2011.
Objective. To determine whether differences exist in 30-day rate of return to the operating
room, mortality, and other perioperative outcomes for spinal fusion by specialty.
Summary of Background Data. Although both neurosurgeons and orthopedic surgeons
perform spinal fusions, it is unclear whether surgeon specialty impacts perioperative
Methods. Unadjusted bivariate analysis was performed to determine whether outcomes
differed by surgeon specialty. A Bonferroni correction was applied to account for multiple
comparisons. For outcomes with a statistically significant association, further multivariate
analysis was performed.
Results. A total of 9719 patients receiving a spinal fusion were identified. Of them, 54.0%
had their operation completed by a neurosurgeon. Orthopedic surgeons had practices
with a greater percentage of lumbar spine cases (76.0% vs 65.0%, P < 0.001). There was not
a statistically significant difference in the number of levels fused or operative technique
used between specialties. There was no difference in the majority of perioperative outcomes between orthopedic surgeons and neurosurgeons including death, rate of return
to the operating room, and other complications associated with significant morbidity. On
unadjusted analysis, it was found that neurosurgeons were associated with a decreased
incidence of operations requiring blood transfusion relative to orthopedic surgeons ( 8.3%
vs. 14.6%, P < 0.001). This trend persisted on multivariate analysis controlling for preoperative hematocrit, history of bleeding disorder, anatomical location of the operation, number
of levels fused, operative technique, demographics, and comorbidities (odds ratio, 0.49;
95% confidence interval, 0.43–0.57).
Conclusion. Spine surgeons, regardless of specialty, seem to achieve equivalent outcomes on measured metrics of mortality, 30-day readmission, and surgical site infection.
Observed differences in blood transfusion rates by specialty were noted, but the cause of
this difference is unclear and warrants further investigation to assess the impact of this
difference, if any, on patient outcomes and cost.
Reprinted with permission from Wolters-Kluwer Health, Inc.
Utilizing the 2005-2011 American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) databases, McCutcheon et al compared 30-day perioperative
outcomes between orthopedic surgeons and neurosurgeons for patients undergoing spinal
fusion surgery. Fusions throughout the spine from different approaches were identified
by Current Procedural Technology (CPT) codes.
Blake N. Shultz, BA,
Jonathan N. Grauer, MD
Department of Orthopaedics and
Rehabilitation, Yale University
School of Medicine
New Haven, CT, USA