Back-to-Back Surgeries in AIS Patients Can be Performed Safely Without Compromising Radiographic or Perioperative Outcomes

Abstract

Study Design. A retrospective chart review of prospectively collected data. Objective. The aim of this study was to determine whether back-to-back scoliosis surgeries can be performed safely without compromising outcomes and the reproducibility of the practice between institutions. Summary of Background Data. During the summer, spinal surgeons will often book multiple cases in one day. The complexity and demands of spinal fusion surgery call into question the safety. Change of operating room staff including anesthesiologists, nurses, and neurologists may introduce new risks. Methods. From 2009 to 2018, index AIS surgeries were included. In Groups 1, 2, and 3, surgeries were performed by a single surgeon. In Group 4, they were performed by other institutional surgeons. Group 1: first surgery of the day, Group 2: second surgery of the day, Group 3: only surgery of the day, Group 4: only surgery of the day by different institutional surgeon. Additional analysis was done to determine reproducibility after a surgeon was moved from Institution 1 to Institution 2. Results. Five hundred sixty-seven AIS patients were analyzed. Group 1 patients had similar radiographic outcomes compared with Group 2 (P > 0.05). Surgical time was similar (P = 0.51), but significantly more levels fused (P = 0.01). Compared with Group 3, Group 2 had a smaller preoperative Cobb (P = 0.02), shorter surgeries (P < 0.001), and length of stay (P = 0.04) but similar complication rate (P = 1). Compared with Group 4, Group 2 had smaller preoperative Cobb (P < 0.001), shorter surgery, and lower complication rate (P = 0.03). When determining reproducibility, institution 2 patients had significantly less blood loss, shorter surgeries, and shorter lengths of stay (P < 0.05). Conclusion. Although long and involved, back-to-back AIS surgeries do not compromise radiographic or perioperative outcomes. Changes in operating team do not appear to impact safety, efficiency, or outcomes. This study also found that the practice is reproducible between institutions. Level of Evidence: 3

Performing Multiple Posterior Spinal Fusions in 1 Day: A Comparison of Perioperative Outcomes Between Morning and Afternoon Cases

“…Based on these results, the perioperative and acute surgical outcomes appear similar across groups, in accordance with previously published results. 5 No previous study has compared pain outcomes between first and second PSF cases, and this study found that postoperative pain outcomes appeared similar between groups. PSF is an intensely invasive procedure and can cause severe postoperative pain, and postoperative use of opioids in the vulnerable adolescent population comes with a risk of later opioid abuse.…”

“…There exists a family preference for elective PSF to treat IS during the summer vacation months, which may strain hospital and staff resources. 5 The ability for a surgeon to perform 2 PSF procedures in 1 day could meet this demand. However, concerns have been raised in both popular and peer-reviewed literature regarding the safety of multiple intensive procedures performed by the same surgeon in 1 day.…”

“…3,4 However, high-volume centers are still limited by the amount of operating room (OR) time available, particularly in the summer when there is a high demand from patients for this elective procedure while on school vacation. 5 A possible solution has been proposed: 1 surgeon performing 2 cases in the same day (morning and afternoon procedures). However, PSF to treat IS is a complex procedure, which may have a high estimated blood loss (EBL) and the possibility of neurological complications that requires a highly trained OR team.…”

“…With surgical innovation, the mean length of stay following PSF has decreased from 3 weeks to 5 to 6 days and even 2 to 4 days at some institutions, allowing for high-volume centers to gain access to hospital beds 3,4. However, high-volume centers are still limited by the amount of operating room (OR) time available, particularly in the summer when there is a high demand from patients for this elective procedure while on school vacation 5. A possible solution has been proposed: 1 surgeon performing 2 cases in the same day (morning and afternoon procedures).…”

“…One recent study, Sarwahi et al,5 discussed pediatric spine surgery and found no disadvantage to undergoing surgery in the afternoon. However, this study was limited to perioperative outcomes (within 30 d of surgery) and did not look at pain outcomes, including patient-reported pain scores and opioid usage, an important type of postoperative outcome 24.…”