TY - JOUR
T1 - Youth and Experience
T2 - The Effect of Surgeon Experience on Outcomes in Cerebral Palsy Scoliosis Surgery
AU - Harms Study Group
AU - Cahill, Patrick J.
AU - Samdani, Amer F.
AU - Brusalis, Christopher M.
AU - Blumberg, Todd
AU - Asghar, Jahangir
AU - Bastrom, Tracey P.
AU - Pasha, Saba
AU - Refakis, Christian A.
AU - Pahys, Joshua M.
AU - Flynn, John M.
AU - Sponseller, Paul D.
N1 - Publisher Copyright:
© 2017 Scoliosis Research Society
PY - 2018/1
Y1 - 2018/1
N2 - Background Series on the learning curve in spinal deformity surgery have been published, but none has addressed neuromuscular spinal deformity, comprised of arguably the most complex cases. We present the first multi-center analysis of the impact of surgeon experience on neuromuscular spinal deformity surgery. Methods A multi-center prospective study of spinal deformity surgery for cerebral palsy (CP) with at least 2 years of follow-up provided the dataset for assessment. Surgeons were categorized into one of two groups based on their self-reported first year of practice: an experienced surgeons (ES) group included those with at least 10 years of experience at the time of surgery and a young surgeons (YS) group included those with fewer than 10 years of experience at time of surgery. Groups were compared in multiple pre-operative, operative, and post-operative outcomes. Results The YS group had 8 surgeons who performed 59 surgeries; the ES group had 13 surgeons who performed 103 cases, with one surgeon's cases distributed in both groups. The YS group had a greater proportion of patients with severe mental retardation (89.7% vs. 68.6%, p =.01). Duration of surgery was greater in the YS group (456 vs. 344 minutes, p <.001). The mean number of levels fused was greater in the ES group (15.9 vs. 15.6, p =.024), caused by increased variation in the upper level of fusion among the ES group. No significant differences were found between groups for estimated blood loss, length of hospitalization, or in percentage of Cobb correction. Years of experience of the operating surgeon was inversely correlated with duration of surgery (rho = −0.476, p <.001). Conclusions In performing scoliosis surgery on CP patients, surgeons with fewer than ten years of practice experience demonstrate significantly greater average operative time and decreased mean number of levels fused, yet produce similar clinical outcomes to more experienced surgeons. Level of Evidence Level III, therapeutic.
AB - Background Series on the learning curve in spinal deformity surgery have been published, but none has addressed neuromuscular spinal deformity, comprised of arguably the most complex cases. We present the first multi-center analysis of the impact of surgeon experience on neuromuscular spinal deformity surgery. Methods A multi-center prospective study of spinal deformity surgery for cerebral palsy (CP) with at least 2 years of follow-up provided the dataset for assessment. Surgeons were categorized into one of two groups based on their self-reported first year of practice: an experienced surgeons (ES) group included those with at least 10 years of experience at the time of surgery and a young surgeons (YS) group included those with fewer than 10 years of experience at time of surgery. Groups were compared in multiple pre-operative, operative, and post-operative outcomes. Results The YS group had 8 surgeons who performed 59 surgeries; the ES group had 13 surgeons who performed 103 cases, with one surgeon's cases distributed in both groups. The YS group had a greater proportion of patients with severe mental retardation (89.7% vs. 68.6%, p =.01). Duration of surgery was greater in the YS group (456 vs. 344 minutes, p <.001). The mean number of levels fused was greater in the ES group (15.9 vs. 15.6, p =.024), caused by increased variation in the upper level of fusion among the ES group. No significant differences were found between groups for estimated blood loss, length of hospitalization, or in percentage of Cobb correction. Years of experience of the operating surgeon was inversely correlated with duration of surgery (rho = −0.476, p <.001). Conclusions In performing scoliosis surgery on CP patients, surgeons with fewer than ten years of practice experience demonstrate significantly greater average operative time and decreased mean number of levels fused, yet produce similar clinical outcomes to more experienced surgeons. Level of Evidence Level III, therapeutic.
KW - Cerebral palsy
KW - Neuromuscular scoliosis
KW - Surgeon experience
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U2 - 10.1016/j.jspd.2017.05.007
DO - 10.1016/j.jspd.2017.05.007
M3 - Article
C2 - 29287818
AN - SCOPUS:85039939284
SN - 2212-134X
VL - 6
SP - 54
EP - 59
JO - Spine deformity
JF - Spine deformity
IS - 1
ER -