Objective:

There are limited data evaluating the outcomes of attending neurosurgeons with different types of first assistants. This study considers a common neurosurgical procedure (single-level, posterior-only lumbar fusion surgery) and examines whether attending surgeons deliver equal patient outcomes, regardless of the type of first assistant (resident physician versus non-physician surgical assistant), among otherwise exact-matched patients.

Methods:

The authors retrospectively analyzed 3,395 adult patients undergoing single-level, posterior-only lumbar fusion at a single academic medical center. Primary outcomes included readmissions, emergency department (ED) visits, reoperation, and mortality within 30 and 90 days after surgery. Secondary outcome measures included discharge disposition, length of stay, and length of surgery. Coarsened exact matching was used to match patients on key demographics and baseline characteristics known to independently affect neurosurgical outcomes.

Results:

Among exact-matched patients (n = 1402) there was no significant difference in adverse postsurgical events (readmission, ED visits, reoperation, or mortality) within 30 days or 90 days of the index operation between patients who had resident physicians versus NPSAs as first assistants. Patients who had resident physicians as first assistants demonstrated a longer length of stay (mean 100.0 vs. 87.4 hours, p < 0.001) and a shorter duration of surgery (mean 187.4 vs. 213.8 minutes, p < 0.001). There was no significant difference between the two groups in the percentage of patients discharged home.

Conclusions:

For single-level posterior spinal fusion, in the setting described, there are no differences in short-term patient outcomes delivered by attending surgeons assisted by resident physicians versus NPSAs.