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Influence of Surgeon Specialty on 30-day Outcomes Following Single-Level Cervical Disc Arthroplasty: A
Puneet Gupta1, Fthimnir M Hassan1, George M Thomas2
1Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, USA.
Insights
Surgeon specialty does not impact 30-day complications after cervical disc arthroplasty (CDA). This study found no increased risk for complications whether the procedure was performed by orthopedic surgeons or neurosurgeons.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spine Surgery
Background:
- Cervical disc arthroplasty (CDA) is increasingly used for degenerative disc disease.
- Surgeon specialty may influence postoperative complication rates in spine surgery.
- The impact of surgeon specialty on CDA outcomes is not well-established.
Purpose of the Study:
- To compare 30-day postoperative complication rates for single-level CDA performed by neurosurgeons versus orthopedic surgeons.
- To investigate if surgical specialty influences the risk of complications following cervical disc arthroplasty.
Main Methods:
- Retrospective analysis of the NSQIP database (2015-2020).
- 1:1 propensity score matching of patients undergoing single-level CDA.
- Multivariate logistic regression to assess the influence of surgical specialty on complications.
Main Results:
- Analysis included 3179 single-level CDAs; 916 matched pairs of orthopedic surgery and neurosurgery patients were generated.
- Orthopedic surgery specialty was not associated with increased odds of any complication (OR: 0.87, P=0.7696).
- No significant difference in any site complication, operative infection, or medical complication rates between the two specialties.
Conclusions:
- This is the first propensity-matched study indicating that surgeon specialty does not affect 30-day complication risks after single-level CDA.
- Outcomes for cervical disc arthroplasty appear consistent regardless of whether performed by neurosurgeons or orthopedic surgeons.
- Findings suggest that patient selection and surgical technique may be more critical than surgeon specialty for CDA safety.
Study Design:
Retrospective, propensity-matched analysis.
Objectives:
Cervical disc arthroplasty (CDA) is being increasingly utilized for cervical disc generation. Surgeon specialty has been shown to influence the risk for postoperative complications in spine surgery, but this has not yet been explored for CDA. Thus, the purpose of this study is to determine whether there is any difference in 30-day complications between patients undergoing single-level CDA by neurosurgeons vs by orthopaedic surgeons.
Methods:
A retrospective, 1:1 propensity score matched analysis was performed using the NSQIP database from 2015 to 2020. Patient demographics, operative characteristics, and postoperative complications were recorded. Independent multivariate logistic regression models were constructed using the propensity-matched dataset to assess surgical specialty influence on any complication, any site complication, any operative infection, and any medical complications.
Results:
3179 single-level CDAs (28.8% orthopaedic surgery patients, 71.2% neurosurgery patients) were identified that met the inclusion criteria. Well-matched cohorts of 916 patients each were generated. After controlling for all possible confounders, orthopedic surgery specialty was not associated with a higher odds for any complication (OR: .87, 95% CI: .35 - 2.20, P = .7696), any site complication (OR: .32, 95% CI: .08 - 1.32, P = .1359), any operative infection (OR: .31, 95% CI: .07 - 1.34), P = .1172), nor any medical complication (OR: 2.11, 95% CI: .62 - 7.20, P = .2311) vs neurosurgery.
Conclusion:
This is the first propensity-matched analysis to show that spine surgeon specialty does not influence the risk for any complication, any site complication, any operative infection, nor any medical complication following single-level CDA within the first 30 days after surgery.
