Lambrechts Mark J, Canseco Jose A, Toci Gregory R, Karamian Brian A, Kepler Christopher K, Smith Michael L, Schroeder Gregory D, Hilibrand Alan S, Heller Joshua E, Grasso Giovanni, Gottfried Oren, Kebaish Khaled M, Harrop James S, Shaffrey Christopher, Vaccaro Alexander R
Department of Orthopedic Surgery, Rothman Orthopedic Institute, Thomas Jefferson University, Philadelphia, PA.
Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA.
Spine (Phila Pa 1976). 2023 May 1;48(9):625-635. doi: 10.1097/BRS.0000000000004554. Epub 2023 Feb 28.
Systematic review and meta-analysis.
To perform a systematic review and meta-analysis to identify if intraoperative or postoperative differences in outcomes exist between orthopedic and neurological spine surgeons.
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.
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.
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); I2 = 80%], overall complication rates [OR, ref: orthopedics: 1.03 (95% CI: 0.97, 1.10); I2 = 70%], reoperation rates [OR, ref: orthopedics: 0.91 (95% CI: 0.82, 1.00); I2 = 86%], or overall length of hospital stay between orthopedic spine surgeons and neurosurgeons [MD: -0.19 days (95% CI: -0.38, 0.00); I2 = 98%]. However, neurosurgeons ordered a significantly lower rate of postoperative blood transfusions [OR, ref: orthopedics: 0.49 (95% CI: 0.41, 0.57); I2 = 75%] while orthopedic spine surgeons had shorter operative times [MD: 14.28 minutes, (95% CI: 8.07, 20.49), I2 = 97%].
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.
系统评价与荟萃分析。
进行系统评价与荟萃分析，以确定骨科脊柱外科医生和神经外科脊柱外科医生在术中或术后的结果是否存在差异。
脊柱外科医生可通过骨科手术或神经外科住院医师培训获得委员会认证，最近的文献比较了基于住院医师培训背景的外科医生之间的手术结果，但结果相互矛盾。
按照系统评价和荟萃分析的首选报告项目指南，对PubMed和Scopus数据库进行检索，纳入比较骨科脊柱外科医生和神经外科医生手术结果的文章。采用纽卡斯尔-渥太华量表来确定研究质量。使用连续变量的均值差（MD）和二项变量的比值比（OR）生成森林图，并报告95%置信区间。
在615个检索词结果中，确定了16项研究纳入分析。对这些研究的评估发现，骨科脊柱外科医生和神经外科医生在再入院率[比值比，参考：骨科：0.99（95%置信区间：0.901，1.09）；I² = 80%]、总体并发症发生率[比值比，参考：骨科：1.03（95%置信区间：0.97，1.10）；I² = 70%]、再次手术率[比值比，参考：骨科：0.91（95%置信区间：0.82，1.00）；I² = 86%]或住院总时长方面没有差异[均值差：-0.19天（95%置信区间：-0.38，0.00）；I² = 98%]。然而，神经外科医生术后输血率显著较低[比值比，参考：骨科：0.49（95%置信区间：0.41，0.57）；I² = 75%]，而骨科脊柱外科医生的手术时间较短[均值差：14.28分钟，（95%置信区间：8.07，20.49），I² = 97%]。
尽管存在显著的数据异质性，但我们的荟萃分析发现，无论进行何种类型的脊柱手术，神经外科医生和骨科脊柱外科医生的再入院率、并发症发生率和再次手术率相似。
