Abstract
BACKGROUND CONTEXT
Surgery to correct adult spinal deformity (ASD) is performed by both neurological
surgeons and orthopedic surgeons. Despite well-documented high costs and complication
rates following ASD surgery, there is a dearth of research investigating trends in
treatment according to surgeon subspeciality.
PURPOSE
The purpose of this investigation was to perform an analysis of surgical trends, costs
and complications of ASD operations by physician specialty using a large, nationwide
sample.
STUDY DESIGN/SETTING
Retrospective cohort study using an administrative claims database.
PATIENT SAMPLE
A total of 12,929 patients were identified with ASD that underwent deformity surgery
performed by neurological or orthopedic surgeons.
OUTCOME MEASURES
The primary outcome was surgical case volume by surgeon specialty. Secondary outcomes
included costs, medical complications, surgical complications, and reoperation rates
(30-day, 1-year, 5-year, and total).
METHODS
The PearlDiver Mariner database was queried to identify patients who underwent ASD
correction from 2010 to 2019. The cohort was stratified to identify patients who were
treated by either orthopedic or neurological surgeons. Surgical volume, baseline characteristics,
and surgical techniques were examined between cohorts. Multivariable logistic regression
was employed to assess the cost, rate of reoperation and complication according to
each subspecialty while controlling for number of levels fused, rate of pelvic fixation,
age, gender, region and Charlson Comorbidity Index (CCI). Alpha was set to 0.05 and
a Bonferroni correction for multiple comparisons was utilized to set the significance
threshold at p ≤.000521.
RESULTS
A total of 12,929 ASD patients underwent deformity surgery performed by neurological
or orthopedic surgeons. Orthopedic surgeons performed most deformity procedures accounting
for 64.57% (8,866/12,929) of all ASD operations, while the proportion treated by neurological
surgeons increased 44.2% over the decade (2010: 24.39% vs. 2019: 35.16%; p<.0005).
Neurological surgeons more frequently operated on older patients (60.52 vs. 55.18
years, p<.0005) with more medical comorbidities (CCI scores: 2.01 vs. 1.47, p<.0005).
Neurological surgeons also performed higher rates of arthrodesis between one and six
levels (OR: 1.86, p<.0005), three column osteotomies (OR: 1.35, p<.0005) and navigated
or robotic procedures (OR: 3.30, p<.0005). Procedures performed by orthopedic surgeons
had significantly lower average costs as compared to neurological surgeons (Orthopedic
Surgeons: $17,971.66 vs. Neurological Surgeons: $22,322.64, p=.253). Adjusted logistic
regression controlling for number of levels fused, pelvic fixation, age, sex, region,
and comorbidities revealed that patients within neurosurgical care had similar odds
of complications to orthopaedic surgery.
CONCLUSIONS
This investigation of over 12,000 ASD patients demonstrates orthopedic surgeons continue
to perform the majority of ASD correction surgery, although neurological surgeons
are performing an increasingly larger percentage over time with a 44% increase in
the proportion of surgeries performed in the decade. In this cohort, neurological
surgeons more frequently operated on older and more comorbid patients, utilizing shorter-segment
fixation with greater use of navigation and robotic assistance.
Keywords
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Article info
Publication history
Published online: May 24, 2023
Accepted:
May 16,
2023
Received in revised form:
April 16,
2023
Received:
January 18,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
CM: Nothing to disclose. RB: Nothing to disclose. DA: Nothing to disclose. AH: Nothing to disclose. JM: Nothing to disclose. CA: Royalties: Stryker (F), Biomet Zimmer Spine (F), DePuy Synthes (F), Nuvasive (B), Next Orthosurgical (F), Medicrea (B); Consulting: DePuy Synthes (B), Medicrea (B), Medtronic (B), K2M (B); Research Support (Investigator Salary, Staff/Materials)^: Titan SPine (E), ISSG (C) CS: Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Trips/Travel: AO Foundation (F); Grants: AO Foundation (F), Nuvasive (D); Fellowship Support NuVasive (G), Globus (G) DH: Nothing to disclose. BD: Nothing to disclose. EK: Consulting: SeaSpine (B), SpineArt (B), Stryker (B) RH: Nothing to disclose. AD: Royalties: Springer (B); Consulting: EOS (B), Medicrea (B), Medtronic (C), Orthofix (C), Spineart (E), Stryker (C); Fellowship Support (D).
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