Objective:

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 study was to investigate the impact of spine surgeon specialty (neurosurgery vs orthopedic surgery) on early perioperative outcome measures of elective anterior/lateral lumbar interbody fusion for degenerative disc diseases.

Methods:

A retrospective, 1:1 propensity score-matched cohort study. 9,070 patients were reviewed from ACS-NSQIP database. Propensity score matching and subgroup analysis were utilized.

Results:

In both groups (single- and multi-level ALIF/LLIF), patients operated on by neurosurgeons had longer operation time (188 vs 172 minutes/ 239 vs 221 minutes), shorter total hospital stay (71 vs 90 hours/ 89 vs 96 hours), and lower rates of return to the operating room (2.1% vs 4.1%/ 2.4% vs 4.2%), non-home discharge (8.7% vs 11.1%/ 10.1% vs 14.9%), discharge after postoperative day 3 (22.0% vs 30.0%/ 38.0% vs 43.9%), and perioperative blood transfusion (2.1% vs 5.1%/ % 5.0 vs 9.9%), (p <0.05). In multi-level ALIF/LLIF, patients operated on by neurosurgeons had lower readmission rates (3.9% vs 6.9%), (p <0.05). Other outcome measures and mortality rates were similar between the single- and multi-level ALIF/LLIF cohorts regardless of surgeon specialty CONCLUSIONS: Our analysis found significant differences in early perioperative outcomes of patients undergoing ALIF/LLIF by neurosurgeons and orthopedic surgeons. These differences have significant clinical and cost implications for patients, physicians, program directors, payors and health systems.