Lumbar Discectomy Outcomes by Specialty: A Propensity-Matched Analysis of 7464 Patients from the ACS-NSQIP Database

Darian R. Esfahani, Harsh Shah, Gregory Arnone, Justin K. Scheer, Ankit I. Mehta

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To investigate the influence of surgeon specialty on 30-day postoperative complication rates for single-level lumbar discectomies. Methods: All patients who underwent single-level lumbar discectomy between 2005 and 2014 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching and univariate binary regression was used to determine whether surgeon subspecialty had an influence on 30-day postoperative complications. Results: Of the 28,863 patients who underwent single-level lumbar discectomies during 2005–2014, 12,659 patients met inclusion criteria. Orthopedic surgeons performed 3733 operations (29.4%), and neurosurgeons performed 8926 operations (70.6%). A propensity-score matched sample of 7464 total cases (3732 orthopedic surgeon, 3732 neurosurgeon) was analyzed for the effect of surgeon specialty on 30-day outcomes. After propensity matching, orthopedic surgeons and neurosurgeons were similar in all postoperative outcomes, except for a slightly higher frequency of blood transfusions (0.3%, n = 11) in orthopedic versus neurosurgery patients (0.1%, n = 3; P = 0.032), although this did not remain significant after Bonferroni adjustment. Mean operative time was slightly longer for neurosurgeons (83.7 minutes) versus orthopedic surgeons (72.5 minutes; P < 0.001). There were no significant differences in mortality, readmission, or reoperation rates. Conclusions: Single-level lumbar discectomies hold a low complication profile and show equivalent outcomes for both orthopedic and neurological surgeons, although neurosurgeons may exhibit a slightly longer mean operative time. In propensity score–matched cohorts, orthopedic surgeons had slightly higher rates of blood transfusions, although the number was small and did not remain significant after Bonferroni adjustment.

Original languageEnglish (US)
Pages (from-to)e865-e870
JournalWorld neurosurgery
Volume118
DOIs
StatePublished - Oct 1 2018

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Diskectomy
Quality Improvement
Databases
Propensity Score
Operative Time
Blood Transfusion
Neurosurgery
Reoperation
Orthopedics
Orthopedic Surgeons
Neurosurgeons
Surgeons
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Esfahani, Darian R. ; Shah, Harsh ; Arnone, Gregory ; Scheer, Justin K. ; Mehta, Ankit I. / Lumbar Discectomy Outcomes by Specialty : A Propensity-Matched Analysis of 7464 Patients from the ACS-NSQIP Database. In: World neurosurgery. 2018 ; Vol. 118. pp. e865-e870.
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title = "Lumbar Discectomy Outcomes by Specialty: A Propensity-Matched Analysis of 7464 Patients from the ACS-NSQIP Database",
abstract = "Objective: To investigate the influence of surgeon specialty on 30-day postoperative complication rates for single-level lumbar discectomies. Methods: All patients who underwent single-level lumbar discectomy between 2005 and 2014 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching and univariate binary regression was used to determine whether surgeon subspecialty had an influence on 30-day postoperative complications. Results: Of the 28,863 patients who underwent single-level lumbar discectomies during 2005–2014, 12,659 patients met inclusion criteria. Orthopedic surgeons performed 3733 operations (29.4{\%}), and neurosurgeons performed 8926 operations (70.6{\%}). A propensity-score matched sample of 7464 total cases (3732 orthopedic surgeon, 3732 neurosurgeon) was analyzed for the effect of surgeon specialty on 30-day outcomes. After propensity matching, orthopedic surgeons and neurosurgeons were similar in all postoperative outcomes, except for a slightly higher frequency of blood transfusions (0.3{\%}, n = 11) in orthopedic versus neurosurgery patients (0.1{\%}, n = 3; P = 0.032), although this did not remain significant after Bonferroni adjustment. Mean operative time was slightly longer for neurosurgeons (83.7 minutes) versus orthopedic surgeons (72.5 minutes; P < 0.001). There were no significant differences in mortality, readmission, or reoperation rates. Conclusions: Single-level lumbar discectomies hold a low complication profile and show equivalent outcomes for both orthopedic and neurological surgeons, although neurosurgeons may exhibit a slightly longer mean operative time. In propensity score–matched cohorts, orthopedic surgeons had slightly higher rates of blood transfusions, although the number was small and did not remain significant after Bonferroni adjustment.",
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Lumbar Discectomy Outcomes by Specialty : A Propensity-Matched Analysis of 7464 Patients from the ACS-NSQIP Database. / Esfahani, Darian R.; Shah, Harsh; Arnone, Gregory; Scheer, Justin K.; Mehta, Ankit I.

In: World neurosurgery, Vol. 118, 01.10.2018, p. e865-e870.

Research output: Contribution to journalArticle

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N2 - Objective: To investigate the influence of surgeon specialty on 30-day postoperative complication rates for single-level lumbar discectomies. Methods: All patients who underwent single-level lumbar discectomy between 2005 and 2014 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching and univariate binary regression was used to determine whether surgeon subspecialty had an influence on 30-day postoperative complications. Results: Of the 28,863 patients who underwent single-level lumbar discectomies during 2005–2014, 12,659 patients met inclusion criteria. Orthopedic surgeons performed 3733 operations (29.4%), and neurosurgeons performed 8926 operations (70.6%). A propensity-score matched sample of 7464 total cases (3732 orthopedic surgeon, 3732 neurosurgeon) was analyzed for the effect of surgeon specialty on 30-day outcomes. After propensity matching, orthopedic surgeons and neurosurgeons were similar in all postoperative outcomes, except for a slightly higher frequency of blood transfusions (0.3%, n = 11) in orthopedic versus neurosurgery patients (0.1%, n = 3; P = 0.032), although this did not remain significant after Bonferroni adjustment. Mean operative time was slightly longer for neurosurgeons (83.7 minutes) versus orthopedic surgeons (72.5 minutes; P < 0.001). There were no significant differences in mortality, readmission, or reoperation rates. Conclusions: Single-level lumbar discectomies hold a low complication profile and show equivalent outcomes for both orthopedic and neurological surgeons, although neurosurgeons may exhibit a slightly longer mean operative time. In propensity score–matched cohorts, orthopedic surgeons had slightly higher rates of blood transfusions, although the number was small and did not remain significant after Bonferroni adjustment.

AB - Objective: To investigate the influence of surgeon specialty on 30-day postoperative complication rates for single-level lumbar discectomies. Methods: All patients who underwent single-level lumbar discectomy between 2005 and 2014 were reviewed from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Propensity score matching and univariate binary regression was used to determine whether surgeon subspecialty had an influence on 30-day postoperative complications. Results: Of the 28,863 patients who underwent single-level lumbar discectomies during 2005–2014, 12,659 patients met inclusion criteria. Orthopedic surgeons performed 3733 operations (29.4%), and neurosurgeons performed 8926 operations (70.6%). A propensity-score matched sample of 7464 total cases (3732 orthopedic surgeon, 3732 neurosurgeon) was analyzed for the effect of surgeon specialty on 30-day outcomes. After propensity matching, orthopedic surgeons and neurosurgeons were similar in all postoperative outcomes, except for a slightly higher frequency of blood transfusions (0.3%, n = 11) in orthopedic versus neurosurgery patients (0.1%, n = 3; P = 0.032), although this did not remain significant after Bonferroni adjustment. Mean operative time was slightly longer for neurosurgeons (83.7 minutes) versus orthopedic surgeons (72.5 minutes; P < 0.001). There were no significant differences in mortality, readmission, or reoperation rates. Conclusions: Single-level lumbar discectomies hold a low complication profile and show equivalent outcomes for both orthopedic and neurological surgeons, although neurosurgeons may exhibit a slightly longer mean operative time. In propensity score–matched cohorts, orthopedic surgeons had slightly higher rates of blood transfusions, although the number was small and did not remain significant after Bonferroni adjustment.

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