Do neurosurgeon spine surgery outcomes differ in any material way from orthopedic spine surgery outcomes? New research from some of the premier academic institutions in the U.S. and Europe not only debunks old stereotypes but provides revealing insights into the very nature of spine surgery itself.
The study, which collected data from 16 other studies, “Spine Surgical Subspecialty and Its Effect on Patient Outcomes—A Systematic Review and Meta-Analysis,” appears in the February 28, 2023, edition of Spine.
The research was conducted by both orthopedic surgeons and neurosurgeons at the following institutions:
- Rothman Orthopaedic Institute, Thomas Jefferson University
- Department of Neurosurgery, Thomas Jefferson University
- Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advance Diagnostics, University of Palermo, Italy
- Department of Neurosurgery, Duke University Medical Center
- Department of Orthopaedic Surgery, The Johns Hopkins University
Co-author Alexander Vaccaro, M.D., Ph.D., M.B.A. told OTW, “Multiple studies have demonstrated that teamwork is key to patient outcomes. Insinuations that one subspecialty is superior to another undermines our efforts to provide the best care for our patients. Having learned of instances where some underpowered studies with unknown biases led readers to believe that one specialty had superior outcomes, my colleagues and I set out to do more thorough research into the issue.”
The authors noted that databases used in prior studies had a lack of “granularity, the high risk for confounding, recording bias, and incomplete data.”
In addition, they found that the lack of information on surgeon volume and experience level in the previously used databases was problematic because both variables are highly correlated with patient outcomes. For this study, the researchers utilized PubMed and Scopus to find articles comparing outcomes between orthopedic spine surgeons and neurosurgeons.
Of the 16 studies, 7 were affiliated with neurosurgical departments, while 5 included orthopedic surgery departments; 4 studies had both neurosurgery and orthopedic surgery affiliations. As far as the type of data, 14 studies utilized registry data, 1 utilized single-institution data, and the remaining study used both single-institution and database data. This variety in data origin allowed for greater generalizability about the ultimate research findings.”
Regarding study quality, the authors relied on the Newcastle–Ottawa scale, a tool for assessing the quality of non-randomized studies included in a systematic review and/or meta-analysis. With this tool, each study is judged on eight items, categorized into three groups: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively. Studies can be assigned a maximum of nine points.1 In the current research, only one study had a quality assessment score of seven or more (affiliations were both neurosurgery and orthopedic surgery).
“A total of 10 studies compared complications, with 8 finding no difference in complication rates between subspecialties,” said Dr. Vaccaro to OTW. “One study found a lower overall complication rate for orthopedics for lumbar fusions (14.5% vs. 16.2%) and anterior cervical discectomy and fusion (9.9% vs. 10.5%). One found a lower complication rate for neurosurgery in the management of isolated spinal fractures (14.3% vs. 22.6%). As for readmissions, again, 10 studies compared this variable, with 8 finding no difference in readmission rates. It was similar for reoperation rates and length of stay.”
“Safety is the ultimate issue in spine surgery,” concluded Dr. Vaccaro to OTW. “Patients will have superior outcomes when orthopedic spine surgeons and neurosurgeons work together to optimize their care throughout their treatment experience.”
Reference: https://en.wikipedia.org/wiki/Newcastle–Ottawa_scale
