The Effect of Two Attending Surgeons on the Outcomes of Posterior Spine Fusion in Children With Cerebral Palsy

Shrader, M. Wade; Wood, William A.; Falk, Miranda; Segal, Lee S.; Boan, Carla; White, Greg R.

doi:10.1016/j.jspd.2018.03.002

Cited by 26 publications

(39 citation statements)

References 24 publications

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“…[ 11 ] The concept of dual attending surgeons is previously studied in pediatric spine surgery. [ 12 – 17 ] These studies demonstrate shorter operative time, decreased blood loss, and shorter hospital length of stay. However, there is limited data supporting the use of 2 attending surgeons in SEMLS for CP surgery.…”

Section: Introductionmentioning

confidence: 82%

Single-event multilevel surgery in cerebral palsy

et al. 2021

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The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons ( P = 0.03). Decreased operative time was associated with an estimated savings of $2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P = 0.11). Decreased operative time was associated with an estimated savings of $1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III

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Section: Introductionmentioning

confidence: 82%

Single-event multilevel surgery in cerebral palsy

et al. 2021

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“…The copresence of two surgeons, mandatory in some countries (eg, Italy) and recommended in other specialties, 9 may questionably increase safety and certainly cost: assuming a 20 min uncomplicated surgery, medical staff cost per surgery varies from US$46 for a single surgeon and available anaesthesiologist, to US$120 for two surgeons and a dedicated anaesthesiologist (table 2), translating into 1.2 million physician hours or 132 million dollars in the USA (assuming US$110 average cost per hour) and about twice as much in Europe! It all doubles for a dedicated anaesthesiologist.…”

Section: Discussionmentioning

confidence: 99%

Cataract surgery practice patterns worldwide: a survey

et al. 2021

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ObjectiveTo report the results of a global survey on cataract practice patterns related to preoperative, intraoperative and postoperative care, surgical setting and personnel allocation.Methods and analysisAn online 28 questions survey was sent to 240 ophthalmologists asking to describe prevailing trends in their institutions across 38 countries and 5 continents. Questions inquired country, institution, surgical volume and setting, anaesthesia, preoperative and intraoperative examination and postsurgical care. Statistical analysis used crosstabs lambda statistics for non-parametric nominal variables. P value less than 0.05 was considered statistically significant.Results209/240 (87%) ophthalmologists responded: 38% representing public hospitals, 36% private practices and 26% academic sites; overall surgical volume was between 241 700 and 410 500 cataracts per year. There was a significant correlation between type of institution and surgical volume. Complete results available in online (https://freeonlinesurveys.com/r/W6BcLLxy).ConclusionCataract surgery related patterns of perioperative care showed significant difference among respondents, regardless to type of institution, surgical volume and country. Many evidence-based procedures are unevenly practiced around the world and some widespread and expensive habits lack solid scientific evidence while consuming enormous amount of resources both monetary and human. There is a need to reach consensus and share evidence-based practice patterns.

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“…Evidence (mostly from spinal and breast surgery) suggests that dual surgeon operating can reduce the duration of surgery, length of hospital stay, blood loss, and may prevent some postoperative complications. 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

Section: Dual Surgeon Operatingmentioning

confidence: 99%

“…Additionally, the pooled expertise of two experienced surgeons decreases operating time. 16 , 17 , 19 , 20 , 21 , 22 …”

Section: Costmentioning

confidence: 99%

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Dual surgeon operating to improve patient safety

Ellis

Hardie

Summerton

et al. 2021

British Journal of Oral and Maxillofacial Surgery

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The COVID-19 pandemic resulted in an unprecedented reduction in the delivery of surgical services worldwide, especially in non-urgent, non-cancer procedures. A prolonged period without operating (or ‘layoff period’) can result in surgeons experiencing skill fade (both technical and non-technical) and a loss of confidence. While senior surgeons in the UK may be General Medical Council (GMC) validated and capable of performing a procedure, a loss of ‘currency’ may increase the risk of error and intraoperative patient harm, particularly if unexpected or adverse events are encountered. Dual surgeon operating may mitigate risks to patient safety as surgeons regain currency while returning to non-urgent operating and may also be beneficial after the greatly reduced activity observed during the COVID-19 pandemic for low-volume complex operations. In addition, it could be a useful tool for annual appraisal, sharing updated surgical techniques and helping team cohesion. This paper explores lessons from aviation, a leading industry in human factors principles, for regaining surgical skills currency. We discuss real and perceived barriers to dual surgeon operating including finance, training, substantial patient waiting lists, and intraoperative power dynamics.

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The Effect of Two Attending Surgeons on the Outcomes of Posterior Spine Fusion in Children With Cerebral Palsy

Cited by 26 publications

References 24 publications

Single-event multilevel surgery in cerebral palsy

Single-event multilevel surgery in cerebral palsy

Cataract surgery practice patterns worldwide: a survey

Dual surgeon operating to improve patient safety

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