Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P64. Comparing 30-day outcomes between orthopedic surgeons and neurosurgeons in lumbar total disc replacement

Abstract

BACKGROUND CONTEXT Orthopedic surgeons and neurosurgeons both perform lumbar total disc replacements (LTDR). However, there is little evidence comparing outcomes between these two specialties for LTDR. It is possible that one specialty achieves superior postoperative complication, reoperation, or readmission rates following LTDR. PURPOSE This study evaluated the: (1) demographics; (2) complications; (3) operative time; (4) length of stay; (5) reoperations; and (6) readmissions of patients following LTDR. We hypothesized that orthopedic surgeons and neurosurgeons achieve similar 30-day postoperative outcomes in complications, reoperations, and readmissions following LTDR surgery. STUDY DESIGN/SETTING Retrospective review of a prospectively collected database. PATIENT SAMPLE All patients who underwent elective lumbar total disc replacement 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 581 patients were identified, 42.9% of whom were treated by orthopedic surgeons and 57.1% 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 lumbar total disc replacements 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 and attempted to identify potential predictive factors for 30-day postoperative complications. RESULTS A total of 581 LTDR patients were included. 42.9% of patients were treated by orthopedic surgeons and 57.1% were treated by neurosurgeons. Orthopedic patients were younger (44.71vs. 47.51years, p=.008) and had lower rates of hypertension (26.9vs. 37.1%, p=.010). Otherwise, the groups were largely comparable in comorbidities and lab values. Orthopedic patients had comparable operative time (159.3vs. 140.0 minutes, p=.731) and but slightly longer length of stay (2.59vs. 2.26days, p=.044) compared to neurosurgery patients. The orthopedic patient group had comparable 30-day complication (6.4vs. 9.3%, p=.203), readmission (1.8vs. 5.0%, p=.052) and reoperation (0.9vs. 1.6%, p=.473) rates compared to neurosurgery patients. Regression analysis revealed patient age was the lone significant predictor for higher overall complication rate (OR 1.04, p CONCLUSIONS This study compared 30-day outcomes between orthopedic surgeons and neurosurgeons in lumbar total disc replacement patients. Neurosurgeons performed lumbar total disc replacements more often than orthopedic surgeons but their outcomes were comparable for 30-day complication, reoperation and readmission rates. Orthopedic surgery patients had slightly longer length of stay. Surgeon specialty was not a significant predictor for 30-day complication rates. Orthopedic surgeons may be under-performing lumbar total disc replacement surgeries despite similar outcomes to neurosurgeons.