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Dual vs. single surgeon in spinal deformity correction: a meta-analysis
Marc Boutros1, Guy Awad1, Shaza Hammad2
1Université Saint-Joseph de Beyrouth, Beyrouth, 11-5076, Lebanon.
Background Context:
Spinal deformity correction is technically demanding and often associated with extended operative time, substantial blood loss, and elevated complication rates. Dual-attending surgeon (DS) models have emerged as a strategy to enhance operative efficiency and patient safety, though published outcomes remain inconsistent.
Purpose:
To evaluate the impact of a DS approach compared with a traditional single-attending surgeon (SS) strategy on perioperative and postoperative outcomes in spinal deformity surgery.
Study Design/Setting:
Meta-analysis of comparative studies assessing DS versus SS procedures for spinal deformity correction.
Methods:
A systematic literature search was performed across PubMed, Scopus, the Cochrane Library, and Google Scholar through November 6, 2025. Seventeen studies met inclusion criteria. DS cases were defined as procedures performed by two attending surgeons; SS cases involved one attending assisted by non-attending personnel. Extracted outcomes included operative time, blood loss, transfusion requirements, hospital length of stay, radiographic correction (Cobb angle), complications, readmission, and revision rates.
Results:
The DS approach was associated with significantly reduced operative time (MD - 109.69 min; 95% CI - 145.04 to - 74.34; p < 0.00001), intraoperative blood loss (MD - 308.90 mL; 95% CI - 454.96 to - 162.83; p < 0.00001), and hospital length of stay (MD - 0.99 days; 95% CI - 1.46 to - 0.52; p < 0.00001). Transfusion risk was also lower in DS cases (RR 0.11; 95% CI 0.03-0.45; p = 0.002). No significant differences were observed in Cobb angle correction (p = 0.84), readmission rates (p = 0.11), revision rates (p = 0.54), or overall complication rates (p = 0.07). Follow-up durations were similar within individual studies but varied across the included literature.
Conclusions:
A DS strategy improves operative efficiency and reduces perioperative blood loss and transfusion requirements, while maintaining equivalent radiographic correction and comparable postoperative outcomes versus the SS model. These findings support selective use of DS approaches, particularly for complex or high-risk deformity cases. Further prospective studies with standardized follow-up and economic analyses are needed to clarify long-term value and cost-effectiveness.
