84. Surgeon specialty effect on early outcomes of elective anterior cervical discectomy and fusion: an updated propensity matched and subgroup analysis of 10,116 patients

Abstract

<h3>BACKGROUND CONTEXT</h3> Comparative effectiveness research has a vital role in health reform and policies. Specialty training is one of these provider-side variables and surgeons who were trained in different specialties may have different outcomes upon performing the same procedure. <h3>PURPOSE</h3> To investigate the impact of spine surgeon specialty on early perioperative outcome of anterior cervical discectomy and fusion (ACDF). <h3>STUDY DESIGN/SETTING</h3> Retrospective, 1:1 propensity score-matched cohort study. <h3>PATIENT SAMPLE</h3> A total of 21,211 patients who underwent ACDF between 2016-2018 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. <h3>OUTCOME MEASURES</h3> Outcomes included 30-day perioperative morbidity and mortality measures that are predefined in the ACS-NSQIP database. <h3>METHODS</h3> Patients were stratified by the specialty of surgeon performing the procedure (neurosurgery vs orthopedic surgery), and the number of levels operated on (single- vs multi-level surgery) <h3>RESULTS</h3> Patients operated on by neurosurgeons were more likely to be older, smokers, of Hispanic ethnicity, functionally dependent, and to have higher BMI, an ASA class 3 or more, baseline dyspnea, bleeding disorders, and myelopathy. In both groups (single/multi-level ACDF), cases in the orthopedic surgery cohort were more likely to have shorter operation time (104 vs 133 minutes/ 138 vs 164 minutes), longer total hospital stay (41 vs 24 hours/ 46 vs 25 hours), higher return to operating room rates within the same admission (2.1% vs 0.7%/ 2.4% vs 0.6%), be discharged to destination other than home (4.6% vs 1.2%/ 4.9% vs 1.0%), be discharged after postoperative day 1 (11.9% vs 6.7%/ 18.9% vs 10.1%), higher perioperative blood transfusion rate (2.1% vs 0.4%/ 3.1% vs 0.6%) and higher sepsis rates (0.7% vs 0.2%/ 0.7% vs 0.1%). In the single-level ACDF group, cases in the orthopedic surgery cohort had higher readmission (4.1% vs 1.9%) and unplanned intubation rates (1.1% vs 0.1%). Other outcome measures and mortality rates were similar among the cohorts. <h3>CONCLUSIONS</h3> Significant differences in early perioperative outcomes of patients undergoing ACDF by neurosurgeons and orthopedic surgeons were noted. These differences have significant clinical and cost implications for patients, physicians, payors and health systems. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.