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The Surgical Outcomes of Pedicle Subtraction Osteotomy per Different First Assistant: Retrospective Analysis of 312 Cases – Lumbar Fusion

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The article investigates the outcomes of pedicle subtraction osteotomies (PSOs), which are complex spinal deformity surgeries, based on the surgical team composition. The study analyzed data from 312 patients who underwent single-level PSO by a fellowship-trained orthopaedic spine surgeon. The results showed that patients with dual-attending surgeons had significantly longer surgical times but experienced lower rates of infection, surgical complications, and readmissions within 30 days of surgery compared to patients with a resident or physician assistant as the first assistant. There were no notable differences among the groups in 2-year complication rates. The study concludes that the dual-attending surgeon approach is supported by the results and suggests the need for additional selection criteria development

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top spine clinic in London

Published article

CONCLUSIONS: These study results support the DA surgeon approach. Resident involvement, even in less complex cases, can still negatively affect perioperative outcomes. Additional selection criteria development is needed.

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J Am Acad Orthop Surg. 2023 Jul 18. doi: 10.5435/JAAOS-D-23-00157. Online ahead of print.ABSTRACTINTRODUCTION: Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician assistant serving as the first assistant. The purpose of this,

J Am Acad Orthop Surg. 2023 Jul 18. doi: 10.5435/JAAOS-D-23-00157. Online ahead of print.

ABSTRACT

INTRODUCTION: Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician assistant serving as the first assistant. The purpose of this study was to determine whether selecting a surgical team for single-level PSO based on case difficulty and fusion length could equalize intraoperative and perioperative outcomes among three groups: dual-attending (DA), attending and orthopaedic resident (RS), and attending and physician assistant (PA).

METHODS: This study was a retrospective cohort analysis of 312 patients undergoing single-level thoracic or lumbar PSO from January 2007 to December 2020 by a fellowship-trained orthopaedic spine surgeon. Demographic, intraoperative, and perioperative data within 30 days and 2 years of the index procedure were analyzed.

RESULTS: Patient demographics did not markedly differ between surgical groups. The mean cohort age was 64.5 years with BMI 31.9 kg/m2. Patients with the DA approach had a significantly longer surgical time (DA = 412 min vs. resident = 372 min vs. physician assistant = 323 min; P < 0.001). Patients within the DA group experienced a significantly lower rate of infection (DA = 2.1% [3/140] vs. RS = 7.9% [9/114] vs. PA = 1.7% [1/58], P = 0.043), surgical complication rate (DA = 26% [37/140] vs. RS = 41% [47/114] vs. PA = 33% [19/58], P < 0 .001), and readmission rate (DA = 6.4% [9/140] vs. RS = 12.3% [14/114] vs. PA = 19% [11/58] P = 0.030) within 30 days of surgery. No notable differences were observed among groups in 2-year complication, infection, readmission, or revision surgery rates.

CONCLUSIONS: These study results support the DA surgeon approach. Resident involvement, even in less complex cases, can still negatively affect perioperative outcomes. Additional selection criteria development is needed.

PMID:37467386 | DOI:10.5435/JAAOS-D-23-00157

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The Surgical Outcomes of Pedicle Subtraction Osteotomy per Different First Assistant: Retrospective Analysis of 312 Cases

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J Am Acad Orthop Surg. 2023 Jul 18. doi: 10.5435/JAAOS-D-23-00157. Online ahead of print.ABSTRACTINTRODUCTION: Pedicle subtraction osteotomies (PSOs) are complex spinal deformity surgeries that are associated with high complication rates. They are typically done by an experienced spine surgeon with another attending, resident, or physician assistant serving as the first assistant. The purpose of this
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