Division of Spine, Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States; Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States.
Division of Musculoskeletal Oncology, Department of Orthopaedics, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, United States.
Clin Neurol Neurosurg. 2020 May;192:105735. doi: 10.1016/j.clineuro.2020.105735. Epub 2020 Feb 10.
Spinal metastases are routinely managed and/or operated on by both orthopaedic surgeons and neurological surgeons. However, controversy still exists as to whether the operating surgeon's specialty has an impact on post-operative complication rates.
The 2007-2017 Humana Administrative Claims database was queried using Current Procedural Terminology codes to identify patients undergoing fusions, laminectomies or osteotomy/corpectomy for spinal metastases. Physician taxonomy codes were used to identify the operating surgeon's specialty (orthopaedic vs. neurosurgery). Multivariate logistic regression analyses were used to assess difference in 90-day complications, readmissions and mortality between the two specialties while controlling for age, gender, race, co-morbidity burden, procedural characteristics (fusion, laminectomy and/or osteotomy/corpectomy) and type of primary cancer.
A total of 887 patients undergoing surgical intervention for spinal metastases were included - out of which 204 (23.0 %) patients were operated on by orthopaedic surgeons and 683 (77.0 %) by neurosurgeons. Following adjustment for difference in patient demographics and baseline clinical characteristics, no statistically significant differences were noted between the two specialties with regards to wound complications (p = 0.992), pulmonary complications (p = 0.461), cardiac complications (p = 0.631), thrombotic complications (p = 0.177), sepsis (p = 0.463), pneumonia (p = 0.767), urinary tract infection (p = 0.916), acute renal failure (p = 0.934), hardware complications (p = 0.892), emergency department visits (p = 0.934), 90-day readmissions (p = 0.277) and 90-day mortality (p = 0.786).
Based off our findings, it appears that a surgeon's specialty has no influence on intermediate-term complications following surgical intervention for spinal metastases. The findings of the study should support the need for maintaining access of patients to both specialties for appropriate surgical consultation.
脊柱转移瘤通常由骨科医生和神经外科医生进行治疗和/或手术。然而，对于手术医生的专业是否会影响术后并发症发生率，仍存在争议。
本研究使用当前手术操作分类代码（Current Procedural Terminology codes）对 2007 年至 2017 年期间 Humana 行政索赔数据库进行了查询，以确定接受脊柱转移瘤融合、椎板切除术或截骨术/椎体切除术的患者。使用医生分类代码识别手术医生的专业（骨科与神经外科）。使用多变量逻辑回归分析评估两种专业在 90 天内并发症、再入院和死亡率的差异，同时控制年龄、性别、种族、合并症负担、手术特征（融合、椎板切除术和/或截骨术/椎体切除术）和原发性癌症类型。
共纳入 887 例接受脊柱转移瘤手术治疗的患者，其中 204 例（23.0%）由骨科医生手术，683 例（77.0%）由神经外科医生手术。在调整患者人口统计学和基线临床特征的差异后，两种专业在伤口并发症（p=0.992）、肺部并发症（p=0.461）、心脏并发症（p=0.631）、血栓并发症（p=0.177）、脓毒症（p=0.463）、肺炎（p=0.767）、尿路感染（p=0.916）、急性肾功能衰竭（p=0.934）、硬件并发症（p=0.892）、急诊科就诊（p=0.934）、90 天再入院（p=0.277）和 90 天死亡率（p=0.786）方面无统计学差异。
根据我们的发现，手术医生的专业似乎对脊柱转移瘤手术后的中期并发症没有影响。研究结果应支持为患者提供两种专业进行适当手术咨询的机会。
