Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH.
Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH.
Spine (Phila Pa 1976). 2024 Jun 1;49(11):772-779. doi: 10.1097/BRS.0000000000004758. Epub 2023 Jul 10.
Retrospective cohort study.
To compare surgical and medical complications profile between neurosurgeons and orthopedic surgeons after transforaminal lumbar interbody fusion (TLIF) procedures.
Studies comparing the impact of spine surgeon specialty (neurosurgery vs. orthopedic spine) on TLIF outcomes have been inconclusive and failed to control for operative learning curves and surgical maturity. Orthopedic spine surgeons perform fewer spine procedures in residency, although these differences may be attenuated by mandatory fellowship before starting practice. Any observed differences are likely attenuated with increasing surgeon experience.
Using an all-payer claims database, PearlDiver Mariner, 120 million patient records were analyzed between 2010 and 2022, to identify individuals with lumbar stenosis or spondylolisthesis who underwent index one- to three-level TLIF procedures. International Classification of Diseases-Ninth Edition (ICD-9), International Classification of Diseases-10th Edition (ICD-10) and Current Procedural Terminology (CPT) codes were used to query the database. Only Neurosurgeons and Orthopedic spine surgeons who had performed at least 250 procedures were included in the study. Patients undergoing surgery for tumor, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with all-cause surgical or medical complications in a linear regression model.
1:1 exact matching created two equal groups of 18,195 patients without baseline differences who underwent TLIF procedures by neurosurgeons or orthopedic surgeons. There was no difference in all-cause surgical complications between neurosurgeons and orthopedic spine surgeons (relative risk=1.008, 95% CI: 0.850-1.195, P =0.965). All-cause medical complication rate was higher in the neurosurgery cohort (relative risk=1.144, 95% CI: 1.042-1.258, P =0.005).
The results of this study suggest that after accounting for surgical maturity, neurosurgeons and orthopedic spine surgeons have similar surgical outcomes. However, neurosurgeons have higher all-cause medical complication rates compared with orthopedic spine surgeons. Further research is warranted to validate this relationship in other spine procedures and for other outcomes.
回顾性队列研究。
比较经椎间孔腰椎体间融合术（TLIF）后神经外科医生和骨科医生的手术和医疗并发症情况。
比较脊柱外科医生专业（神经外科与骨科脊柱）对 TLIF 结果影响的研究尚无定论，且未能控制手术学习曲线和手术成熟度。骨科脊柱外科医生在住院医师培训期间进行的脊柱手术较少，尽管这些差异可能因在开始执业前强制性进修而减弱。任何观察到的差异都可能随着外科医生经验的增加而减弱。
使用全民支付索赔数据库 PearlDiverMariner，分析了 2010 年至 2022 年期间的 1.2 亿份患者记录，以确定患有腰椎管狭窄症或脊椎滑脱症且接受过索引 1-3 级 TLIF 手术的个体。使用国际疾病分类第 9 版（ICD-9）、国际疾病分类第 10 版（ICD-10）和当前手术术语（CPT）代码查询数据库。只有进行了至少 250 例手术的神经外科医生和骨科脊柱外科医生才被纳入研究。排除因肿瘤、创伤或感染而接受手术的患者。使用线性回归模型对与所有原因手术或医疗并发症显著相关的人口统计学因素、合并症和手术因素进行 1:1 精确匹配。
通过神经外科医生或骨科脊柱外科医生进行 TLIF 手术的 18195 名患者进行了 1:1 精确匹配，没有基线差异。神经外科医生和骨科脊柱外科医生之间的所有原因手术并发症无差异（相对风险=1.008，95%CI：0.850-1.195，P=0.965）。神经外科组的所有原因医疗并发症发生率更高（相对风险=1.144，95%CI：1.042-1.258，P=0.005）。
本研究结果表明，在考虑手术成熟度后，神经外科医生和骨科脊柱外科医生的手术结果相似。然而，与骨科脊柱外科医生相比，神经外科医生的所有原因医疗并发症发生率更高。需要进一步的研究来验证在其他脊柱手术和其他结果中这种关系。
