Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
World Neurosurg. 2019 Nov;131:e447-e453. doi: 10.1016/j.wneu.2019.07.194. Epub 2019 Aug 12.
Lumbar fusions are routinely performed by either orthopedic or neurologic spine surgeons. Controversy still exists as to whether a provider's specialty (orthopedic vs. neurosurgery) influences outcomes.
The 2007-2015Q2 Humana Commercial Database was queried using Current Procedural Terminology codes (22612, 22614, 22630, 22632, 22633 and 22634) to identify patients undergoing elective 1-to-2 level posterior lumbar fusions (PLFs) with active enrollment up to 90 days after procedure. Ninety-day complication rates were calculated for the 2 specialties. The surgical and 90-day resource utilization costs for the 2 groups were compared, by studying average reimbursements for acute-care and post-acute-care categories. Ninety-day complications and costs were compared using multivariable logistic and linear regression analyses.
A total of 10,509 patients (5523 orthopedic and 4986 neurosurgery) underwent an elective 1-to-2 level PLF during the period. With the exception of a significantly lower odds of wound complications (odds ratio, 0.81) and a higher odds of dural tears (odds ratio, 1.29) in elective PLFs performed by orthopedic surgeons, no statistically strong differences were seen in 90-day complication rates between the 2 groups. Total 90-day costs were also similar between orthopedic surgeons and neurosurgeons, with the only exception being that surgeon reimbursement was lower for orthopedic surgery versus neurosurgery ($1202 vs. $1372; P < 0.001).
It seems that a provider's specialty does not largely influence 90-day surgical outcomes and costs after elective PLFs. The results of the study promote the formation and acceptance of dual training pathways for entry into spine surgery.
腰椎融合术通常由骨科或神经外科脊柱外科医生进行。目前仍存在争议,即提供者的专业(骨科与神经外科)是否会影响结果。
使用当前手术程序代码(22612、22614、22630、22632、22633 和 22634),对 2007 年至 2015 年第二季度的 Humana 商业数据库进行查询,以确定接受择期 1 至 2 级后路腰椎融合术(PLF)的患者,术后 90 天内有活跃登记。计算这两个专业的 90 天并发症发生率。通过研究急性护理和康复后护理类别的平均报销费用,比较两组的手术和 90 天资源利用成本。使用多变量逻辑和线性回归分析比较 90 天并发症和成本。
在此期间,共有 10509 名患者(5523 名骨科和 4986 名神经外科)接受了择期 1 至 2 级 PLF。除了骨科医生进行的择期 PLF 中伤口并发症的可能性明显较低(优势比为 0.81)和硬膜撕裂的可能性较高(优势比为 1.29)外,两组之间 90 天并发症发生率没有统计学上的显著差异。骨科医生和神经外科医生的总 90 天费用也相似,唯一的例外是骨科手术的医生报销低于神经外科手术(1202 美元与 1372 美元;P<0.001)。
似乎提供者的专业并不在很大程度上影响择期 PLF 后的 90 天手术结果和成本。该研究的结果促进了脊柱外科双培训途径的形成和接受。