The following is a summary of “Comparative Analysis of Early Outcomes and Complications of PSO Among Neurosurgeons and Orthopedic Surgeons,” published in the June 2023 issue of Spinal Disorders and Techniques by McNeill, et al.
The study’s design was a retrospective cohort study utilizing the National Surgical Quality Improvement Program. This study aimed to evaluate trends in the number of PSOs performed annually, characterize the patient populations associated with each cohort, and compare outcomes across specialties. Pedicle subtraction osteotomies (PSO) are complex and advanced surgical procedures performed by neurosurgeons and orthopedic surgeons to correct spinal deformities. Even though both groups of surgeons may be equally qualified and credentialed to perform a PSO, differences in training and experience may result in disparities in patient management and outcomes. Patients in the American College of Surgeons-National Surgical Quality Improvement Program registry who underwent lumbar PSO between 2005 and 2014 were identified. Relevant demographic, preoperative, and 30-day postoperative complications were queried and evaluated.
The data was segregated into two cohorts of patients treated by neurosurgeons and orthopedic surgeons. The Morbidity and Mortality database of the Scoliosis Research Society was queried and analyzed for comparative purposes. Demographic and comorbidity factors were comparable between the neurosurgery and orthopedic surgery cohorts, except for higher hypertension rates among orthopedic surgeon-performed PSOs (65.66 vs. 48.67%, P = 0.001). In each year except 2012, orthopedic surgeons reported more PSOs than neurosurgeons. There was a higher incidence of PSOs in patients who underwent lumbar fusion surgery when the surgery was performed by an orthopedic surgeon (OR 1.7824, 95% CI: 1.4017–2.2556).
Deep vein thrombosis after PSOs was significantly higher in neurosurgery than in orthopedic surgery (P=0.004). However, except for deep vein thrombosis, there were no significant differences in the rates of surgical complications between neurosurgeon- and orthopedic surgeon-performed PSOs. The number of PSO procedures performed by neurosurgeons and orthopedic surgeons has increased annually over the past decade. Differences in outcomes between neurosurgeons and orthopedic surgeons suggest an opportunity for a broader evaluation and alignment of exposure to and training in adult spinal deformity surgery across specialties.
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