Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P124. Comparing 30-day outcomes after anterior cervical discectomy and fusion between orthopaedic surgeons and neurosurgeons: an eight-year analysis

Abstract

BACKGROUND CONTEXT Orthopaedic surgeons and neurosurgeons both perform anterior cervical discectomy and fusions (ACDF) but there is little evidence comparing outcomes between these two specialties for ACDF. It is possible that one specialty achieves superior postoperative complication, reoperation, or readmission rates following ACDF. PURPOSE This study evaluated the: (1) demographics, (2) complications, (3) operative time, (4) length of stay, (5) reoperations and (6) readmissions of patients following ACDF. We hypothesized that orthopedic surgeons and neurosurgeons achieve similar 30-day postoperative outcomes in complications, reoperations and readmissions following ACDF surgery. STUDY DESIGN/SETTING Retrospective review of a prospectively collected database. PATIENT SAMPLE All patients who underwent elective ACDF surgery between 2008 and 2016 and were eligible for at least 30-day follow-up were identified from the National Surgical Quality Improvement Program (NSQIP) database. A total of 77,071 patients were identified, 33.1% of which were treated by orthopaedic surgeons and 66.9% treated by neurosurgeons. OUTCOME MEASURES Demographic information, complications, operative time, length of stay, reoperations and readmissions METHODS The National Surgical Quality Improvement Program (NSQIP) database was utilized to identify all elective ACDFs performed from 2008 to 2016 by ICD-9-CM code. This cohort was grouped by surgeon specialty (orthopedic surgeon and neurosurgeon). Demographics including age, sex, race and Charlson or Deyo score, as well as comorbidities, labs, perioperative factors and 30-day postoperative complication, reoperation and readmission rates were collected for all patients. The groups were then compared with univariate analysis. Regression models were developed to identify potential predictive factors for 30-day postoperative outcomes. RESULTS A total of 77,071 ACDF patients were included. Of these, 33.1% of patients were treated by orthopedic surgeons and 66.9% by neurosurgeons. Orthopedic patients were older (56.0vs. 55.8 years) and had lower rates of smokers (23.7vs. 26.8%), diabetes mellitus (15.0vs. 16.1%) and COPD (3.9vs. 4.5%) (all p CONCLUSIONS This study compared 30-day postoperative outcomes between orthopedic surgeons and neurosurgeons in ACDF patients. Neurosurgeons performed ACDF more often than orthopedic surgeons but their outcomes were comparable for 30-day complications, reoperations and readmissions. Orthopedic patients had longer length of stay but orthopedic specialty was also a predictor for lower 30-day readmission rate.Orthopedic surgeons may be under-performing ACDF surgeries despite largely comparable outcomes to neurosurgeons.