Optimizing Surgery for Idiopathic Scoliosis: Does a Dual Approach Help Young Surgeons?

Introduction In idiopathic scoliosis surgery, studies have shown two attending surgeons have better curve correction, pain, and recovery time. There is conflicting evidence on operative time, blood loss, infection rate, and hospital length of stay. Limited literature examines the impact of surgeon experience on the dual approach. The purpose of this study was to evaluate the performance of two young orthopedic attendings compared to a senior-level attending in idiopathic scoliosis surgery. Methods We examined adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion by a single or dual-attending approach. We performed a 1:1 propensity score match with the variables of age at surgery, sex, body mass index, Cobb angle, and number of levels fused. Peri- and postoperative outcomes were analyzed.  Results There were 24 patients in each cohort. Patients having surgery by dual attendings had a shorter mean operative time overall (232 vs. 327 minutes, p<0.001) and per levels fused (19 vs. 26 minutes per level, p<0.001). Dual attendings had better percent curve correction (70% vs. 56%, p=0.001) and smaller overall final postoperative curve magnitude (17° vs. 25°, p<0.001). Estimated blood loss (421 vs. 989 mL, p=0.023) and cell saver volume transfused (59 vs. 178 mL, p<0.001) were lower in dual attending cases. Dual attending patients had a shorter length of stay (3 vs. 4 days, p<0.001). There were no differences in Hemovac blood loss, transfusion requirements, need for intensive care, or complications. Over time, the young dual attendings improved in hospital length of stay (R: -0.617, p=0.001) and hemovac blood loss (R: -0.474, p=0.019).  Conclusion A dual attending approach in idiopathic scoliosis surgery may result in shorter operative time, greater curve correction, reduced operative blood loss, and shortened hospital length of stay. No differences were identified in postoperative blood loss or transfusion requirement, need for intensive care, or overall complication rate. Within the limitations of this study, we conclude that dual attending surgery in idiopathic scoliosis is safe and effective when conducted by two young orthopedic surgeons, with results that are similar to that of a more experienced senior surgeon.