Does the Specialty of the Surgeon Performing Elective Anterior/Lateral Lumbar Interbody Fusion for Degenerative Spine Disease Correlate with Early Perioperative Outcomes?

Alomari, Safwan; Porras, Jose L.; Lo, Sheng-Fu Larry; Theodore, Nicholas; Sciubba, Daniel M.; Witham, Timothy F.; Bydon, Ali

doi:10.1016/j.wneu.2021.08.010

Cited by 7 publications

(36 citation statements)

References 35 publications

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“…The operative duration was reported in 5 studies, and 4 found orthopedics to have a shorter operative duration 3,4,8,24. Meta-analysis demonstrated orthopedic spine surgeons had shorter operative duration when compared with neurosurgeons [MD: 14.28 minutes (95% CI: 8.07, 20.49), I 2 = 97%].…”

Section: Resultsmentioning

confidence: 99%

“…Intuitively, the inclusion of both orthopedic spine surgeons and neurosurgeons on a manuscript will provide for appropriate vetting before publication and may mitigate the number of flawed studies passing through peer review. 3,4 In most instances, studies with obvious publication bias are removed from a meta-analysis; however, part of the objective of this study was to include publications regardless of potential bias with the understanding that this topic may engender more disagreement among spine surgeons due to the practitioner's inherent bias and financial incentives. Unfortunately, this was not possible after analysis of the funnel plots, which indicated significant bias was present, especially from studies originating from one surgical group that published on complication and readmission rates in patients undergoing ALIFs and ACDFs.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in forest plots and funnel plots were labeled numerically (Table 2). Subsequent meta-analyses were performed after the exclusion of two studies (4 subgroups) with significant heterogeneity when appropriate 3,4. All statistical analyses were performed using R Studio (Version 3.6.3, Vienna, Austria).…”

Section: Methodsmentioning

confidence: 99%

“…1,2 Unfortunately, under the guise of "comparative effectiveness research", biased studies have circulated regarding the superiority of one subspecialty over the other, antagonizing the valuable collaboration between orthopedic and neurological spine surgeons. [3][4][5] Both orthopedic and neurological spine surgeons have valuable insights and the clinical acumen necessary to provide high-quality patient care. Collaboration is important to improve patient care and research efforts should be focused on improving clinical outcomes rather than proving subspecialty superiority.…”

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confidence: 99%

“…Although orthopedic surgeons and neurosurgeons have different training backgrounds, both receive substantial spine-specific training 1,2. Unfortunately, under the guise of “comparative effectiveness research”, biased studies have circulated regarding the superiority of one subspecialty over the other, antagonizing the valuable collaboration between orthopedic and neurological spine surgeons 3–5…”

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confidence: 99%

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Spine Surgical Subspecialty and Its Effect on Patient Outcomes

Lambrechts

Canseco

Toci

et al. 2023

Spine

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Study Design. Systematic review and meta-analysis. Objective. To perform a systematic review and meta-analysis to identify if intraoperative or postoperative differences in outcomes exist between orthopedic and neurological spine surgeons. Summary of Background Data. Spine surgeons may become board certified through orthopedic surgery or neurosurgical residency training, and recent literature has compared surgical outcomes between surgeons based on residency training background with conflicting results. Materials and Methods. Using Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a search of PubMed and Scopus databases was conducted and included articles comparing outcomes between orthopedic spine surgeons and neurosurgeons. The Newcastle-Ottawa scale was used to determine the quality of studies. Forest plots were generated using mean differences (MD) for continuous variables and odds ratios (OR) for binomial variables, and 95% CI was reported. Results. Of 615 search term results, 16 studies were identified for inclusion. Evaluation of the studies found no differences in readmission rates [OR, ref: orthopedics: 0.99 (95% CI: 0.901, 1.09); I 2 = 80%], overall complication rates [OR, ref: orthopedics: 1.03 (95% CI: 0.97, 1.10); I 2 = 70%], reoperation rates [OR, ref: orthopedics: 0.91 (95% CI: 0.82, 1.00); I 2 = 86%], or overall length of hospital stay between orthopedic spine surgeons and neurosurgeons [MD: −0.19 days (95% CI: −0.38, 0.00); I 2 = 98%]. However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions [OR, ref: orthopedics: 0.49 (95% CI: 0.41, 0.57); I 2 = 75%] while orthopedic spine surgeons had shorter operative times [MD: 14.28 minutes, (95% CI: 8.07, 20.49), I 2 = 97%]. Conclusions. Although there is significant data heterogeneity, our meta-analysis found that neurosurgeons and orthopedic spine surgeons have similar readmission, complication, and reoperation rates regardless of the type of spine surgery performed.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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