Single- versus Dual-Attending Surgeon Approach for Spine Deformity: A Systematic Review and Meta-Analysis.

BACKGROUND Surgical management of spine deformity is associated with significant morbidity. Recent literature has inconsistently demonstrated better outcomes after utilizing 2 attending surgeons for spine deformity. OBJECTIVE To conduct a systematic review and meta-analysis on studies reporting outcomes following single- vs dual-attending surgeons for spine deformity. METHODS MEDLINE, Embase, Web of science, and Cochrane databases were last searched on July 16, 2020. A total of 1013 records were identified excluding duplicates. After screening, 10 studies (4 cohort, 6 case series) were included in the meta-analysis. Random-effect models were used to pool the effect estimates by study design. When feasible, further subgroup analysis by deformity type was conducted. RESULTS A total of 953 patients were analyzed. Pooled results from propensity score-matched cohort studies revealed that the single-surgeon approach was unfavorably associated with a nonstatistically significant higher blood loss (mean difference = 421.0 mL; 95% CI: -28.2, 870.2), a statistically significant higher operative time (mean difference = 94.3 min; 95% CI: 54.9, 133), length of stay (mean difference = 0.84 d; 95% CI: 0.46, 1.22), and an increased risk of complications (Mantel-Haenszel risk ratio = 2.93; 95% CI: 1.12, 7.66). Data from pooled case series demonstrated similar results for all outcomes. Moreover, these results did not differ significantly between deformity types (adolescent idiopathic scoliosis and adult spinal deformity). CONCLUSION Dual-attending surgeon approach appeared to be associated with reduced operative time, shorter hospital stays, and reduced risk of complications. These findings may potentially improve outcomes in surgical treatment of spine deformity.

[1]  Allen L. Ho,et al.  Single- versus dual-attending strategy for spinal deformity surgery: 2-year experience and systematic review of the literature. , 2020, Journal of neurosurgery. Spine.

[2]  Timothy R. Smith,et al.  Minimally invasive versus open surgery for the correction of adult degenerative scoliosis: a systematic review , 2020, Neurosurgical Review.

[3]  R. Sethi,et al.  Two Surgeon Approach for Complex Spine Surgery: Rationale, Outcome, Expectations, and the Case for Payment Reform. , 2019, The Journal of the American Academy of Orthopaedic Surgeons.

[4]  K. S. Yeo,et al.  Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°): The Role of a Dual Attending Surgeon Strategy , 2019, Spine.

[5]  M. Shrader,et al.  The Effect of Two Attending Surgeons on the Outcomes of Posterior Spine Fusion in Children With Cerebral Palsy. , 2018 .

[6]  M. Shrader,et al.  The Effect of Two Attending Surgeons on Patients With Large-Curve Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion. , 2017 .

[7]  C. Ames,et al.  Adult Scoliosis Deformity Surgery: Comparison of Outcomes Between One Versus Two Attending Surgeons , 2017, Spine.

[8]  Justin K Scheer,et al.  Results of the 2015 Scoliosis Research Society Survey on Single Versus Dual Attending Surgeon Approach for Adult Spinal Deformity Surgery , 2017, Spine.

[9]  Jun S. Kim,et al.  Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients , 2017, Global spine journal.

[10]  C. Chan,et al.  Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in Lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? A prospective propensity matching score analysis. , 2017, The spine journal : official journal of the North American Spine Society.

[11]  J. Mooney,et al.  Complications following spine fusion for adolescent idiopathic scoliosis , 2016, Current Reviews in Musculoskeletal Medicine.

[12]  C. Chan,et al.  Perioperative Outcome in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Prospective Study Comparing Single Versus Two Attending Surgeons Strategy , 2016, Spine.

[13]  Justin K Scheer,et al.  A Comprehensive Review of Complication Rates After Surgery for Adult Deformity: A Reference for Informed Consent , 2015, Spine deformity.

[14]  N. Laird,et al.  Meta-analysis in clinical trials revisited. , 2015, Contemporary clinical trials.

[15]  R. Fessler,et al.  Cost minimization in treatment of adult degenerative scoliosis. , 2015, Journal of neurosurgery. Spine.

[16]  Alan H. Daniels,et al.  Surgical treatment of adolescent idiopathic scoliosis in the United States from 1997 to 2012: an analysis of 20,346 patients. , 2015, Journal of neurosurgery. Pediatrics.

[17]  Oscar D. Guillamondegui,et al.  How slow is too slow? Correlation of operative time to complications: an analysis from the Tennessee Surgical Quality Collaborative. , 2015, Journal of the American College of Surgeons.

[18]  R. Betz,et al.  The effect of surgeon experience on outcomes of surgery for adolescent idiopathic scoliosis. , 2014, The Journal of bone and joint surgery. American volume.

[19]  J. Leveque,et al.  The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates , 2014, Spine deformity.

[20]  K. Noonan,et al.  Comparing results of posterior spine fusion in patients with AIS: Are two surgeons better than one? , 2013, Journal of orthopaedics.

[21]  Juan S. Uribe,et al.  Current Status of Adult Spinal Deformity , 2012, Global Spine Journal.

[22]  V. Deviren,et al.  Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons , 2013, Spine deformity.

[23]  R. Crawford,et al.  Morbidity and mortality in adult spinal deformity surgery: Norwich Spinal Unit experience , 2013, European Spine Journal.

[24]  K. Bridwell,et al.  Risk-Benefit Assessment of Surgery for Adult Scoliosis: An Analysis Based on Patient Age , 2011, Spine.

[25]  O. Boachie-Adjei,et al.  Scoliosis Research Society Morbidity and Mortality of Adult Scoliosis Surgery , 2011, Spine.

[26]  J. Lawrence,et al.  Complications in Spinal Deformity Surgery: Issues Unrelated Directly to Intraoperative Technical Skills , 2010, Spine.

[27]  A. Stang.  Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses , 2010, European Journal of Epidemiology.

[28]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[29]  L. Lenke,et al.  Adult Spinal Deformity Surgery: Complications and Outcomes in Patients Over Age 60 , 2007, Spine.

[30]  G. Guyatt,et al.  Systems for grading the quality of evidence and the strength of recommendations I: Critical appraisal of existing approaches The GRADE Working Group , 2004, BMC health services research.

[31]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[32]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[33]  P. Lipsett,et al.  Does intraoperative blood loss affect antibiotic serum and tissue concentrations? , 1996, Archives of surgery.

[34]  D. Polly,et al.  The Effect of Intraoperative Blood Loss on Serum Cefazolin Level in Patients Undergoing Instrumented Spinal Fusion: A Prospective, Controlled Study , 1996, Spine.

[35]  J. R. Landis,et al.  A general overview of Mantel-Haenszel methods: applications and recent developments. , 1988, Annual review of public health.

[36]  N. Laird,et al.  Meta-analysis in clinical trials. , 1986, Controlled clinical trials.

[37]  S. Höglund.  [Complications in blood transfusion]. , 1972, Lakartidningen.