Dual attending surgeon strategy learning curve in single-staged posterior spinal fusion (PSF) surgery for 415 idiopathic scoliosis (IS) cases

Abstract

BACKGROUND CONTEXTThe implementation of a dual attending surgeon strategy had improved perioperative outcomes of idiopathic scoliosis (IS) patients. Nevertheless, the learning curve of a dual attending surgeon practice in single-staged posterior spinal fusion (PSF) surgery has not been established. OBJECTIVETo evaluate the surgical learning curve of a dual attending surgeon strategy in IS patients. STUDY DESIGNRetrospective study. PATIENT SAMPLE415 IS patients (Cobb angle <90°) who underwent PSF using a dual attending surgeon strategy OUTCOME MEASURESPrimary outcomes included operative time, total blood loss, allogenic blood transfusion requirement, length of hospital stay and perioperative complication rate. METHODSRegression analysis using Locally Weighted Scatterplot Smoothing (LOWESS) method was applied to create the best-fit-curve between case number versus operative time and total blood loss in identifying cut-off points for the learning curve. RESULTSThe mean Cobb angle was 60.8±10.8°. Mean operative time was 134.4±32.1 minutes and mean total blood loss was 886.0±450.6 mL. The mean length of hospital stay was 3.0±1.6 days. The learning curves of a dual attending surgeon strategy in this study were established at the 115th case (operative time) and 196th case (total blood loss) respectively (p<.001). In comparison of cases before and after the cut-off points, mean operative time reduced significantly from 147.2±36.5 minutes to 129.5±28.9 minutes and mean total blood loss reduced significantly from 1015.1±506.6 mL to 770.4±357.3 mL (p<.001). No allogenic blood transfusion was required and there were 7 perioperative complications (n=7/415, 1.7%) recorded. CONCLUSIONThe learning curve of a dual surgeon strategy in single-staged PSF surgery based on operative time and total blood loss were established at 115th case and 196th case respectively (p<.001).