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Isolating the Effect of Surgeon Experience on Spine Surgery Outcomes: A Retrospective Cohort Study Stratified by
Arun K Movva1, Cade F Bennett, Kaitlyn L Hurka
1From the Northwestern University Feinberg School of Medicine, Chicago, IL (Movva, Bennett, and Hurka); and Northwestern Memorial Hospital Department of Orthopaedic Surgery, Chicago, IL (Joaquin, Patel, Divi).
Introduction:
Outcomes research for spinal surgery has typically focused on patient, diagnosis, or procedure as a predictor of surgical results; the impact of surgeon experience remains uncertain. Although experience improves scoliosis correction and total disk arthroplasty outcomes, its effects on common procedures, including lumbar fusions, anterior cervical diskectomy and fusion (ACDF), and posterior cervical decompression and fusion (PCDF), remain understudied. This study evaluates the impact of surgeon experience on outcomes in a large, multisurgeon, multisite academic center, examining prospectively collected data.
Methods:
We analyzed 1,567 ACDF, 248 PCDF, and 1,834 lumbar fusion cases (2003 to 2023) from a multisite academic center. Data were captured prospectively but reviewed retrospectively. Cohorts were stratified by levels of fusion and procedure type. Outcomes assessed included readmissions, sepsis, surgical site infection (SSI), wound dehiscence, and long-term complications. Multivariate logistic regression was done, adjusting for age, body-mass index, sex, race, diagnoses, primary surgeon, and Elixhauser comorbidities.
Results:
Increased surgeon experience markedly reduces long-term complications in lumbar fusion (odds ratio [OR]: 0.83, confidence interval [CI], 0.79 to 0.88, P < 0.001) and PCDF (OR: 0.71, CI, 0.60 to 0.85, P < 0.001), along with decreasing SSI rates in lumbar fusion (OR: 0.84, CI, 0.75 to 0.94, P = 0.002). Similar effects were observed in lumbar fusion subgroups, stratified by level (single- or multilevel) and procedure (anterior lumbar interbody fusion or posterior lumbar fusion/transforaminal lumbar interbody fusion). No notable associations with experience were observed for ACDF, including long-term complications (OR: 0.93, CI, 0.76 to 1.13, P = 0.440). Notably, a notable increase in sepsis risk correlated with increased experience in lumbar fusion (OR: 1.32, CI, 1.04 to 1.68, P = 0.024).
Level Of Evidence:
Level III.
Conclusion:
Surgeon experience markedly reduces complications and improves lumbar fusion and PCDF outcomes, emphasizing its value in optimizing care while challenging the notion that surgeons are interchangeable.
