Surgeon Specialty Effect on Early Outcomes of Elective Posterior/Transforaminal Lumbar Interbody Fusions: An Updated Propensity-Matched and Subgroup Analysis of 13,072 Patients

Abstract Comparative effectiveness research has a vital role in recent health reform and policies. Specialty training is one of these provider-side variables and surgeons who were trained in different specialties may have different outcomes upon performing the same procedure. The objective of this retrospective 1:1 propensity score-matched cohort study was to investigate the impact of spine surgeon specialty (neurosurgery vs orthopedic surgery) on early perioperative outcome measures of elective posterior/transforaminal lumbar interbody fusion for degenerative spine diseases. 22,176 patients were reviewed from ACS-NSQIP database. Propensity score matching and subgroup analysis were utilized. After controlling for baseline characteristics in both groups (single/multi-level PLIF/TLIF), patients operated on by neurosurgeons were more likely to have longer operation time (239 vs 205 minutes / 276 vs 254 minutes), shorter total hospital stay (75 vs 96 hours / 85 vs 103 hours), lower return to operating room rates within the same admission (2.2% vs 4.2% / 2.5% vs 4.3%), lower non-home discharge (8.8% vs 12.7% / 10.8% vs 18.2%), lower discharge rate after postoperative day 3 (28% vs 31.8% / 38.1% vs 43.9%), lower readmission rates (4.4% vs 6.5% / 4.5% vs 7.5%) and lower perioperative blood transfusion rate (2.7% vs 6.0% / 11.0% vs 14.1%), (p < 0.05). Other outcome measures and mortality rates were similar among the 2 cohorts in both groups. Our analysis found significant differences in early perioperative outcomes of patients undergoing PLIF/TLIF by neurosurgeons and orthopedic surgeons. These differences have significant clinical and cost implications for patients, physicians, program directors, payors and health systems.