Major Spinal Procedures Outcome Differences by Surgical Specialty in Low-Acuity Patients

Introduction: Spinal surgery encompasses a broad spectrum of diagnoses, procedure types, anatomical locations, and patient outcomes, and is typically performed by neurosurgeons or orthopedic surgeons. In this study, we aim to determine if the outcomes of the low American Society of Anesthesiologists (ASA) classification (ASA 1&2) patients undergoing spine surgery vary based on whether the operating surgeon was an orthopedic surgeon or a neurosurgeon as detailed analyses comparing specialty-specific spinal procedure outcomes are limited.

Methods: The NSQIP databases from 2015 to 2021 were queried based on the CPT code for 9 common spine procedures. Patients were stratified into three spinal procedure groups by anatomical clusters (cervical procedure codes, lumbar procedure codes, and combined spinal procedure codes) since spinal operations are rarely completed as single CPT codes but rather as clusters of procedures (e.g., laminectomy plus fusion). Indicators of surgical course and successful outcomes were documented and compared between specialties.

Results: Neurosurgeons had shorter operative times in the ASA 1&2 combined classification (ASA-C) group for cervical, lumbar, and combined spinal procedural groups. In the ASA-C class, neurosurgeons treated patients with more comorbidities. Neurosurgeons had a lower percentage of perioperative transfusions in the ASA-C class for cervical, lumbar, and combined groups. Orthopedic surgeons had shorter lengths of stay for the cervical groups in ASA-C and ASA-1 classes (ASA-1).

Conclusion : Noticeably higher rates of spinal preoperative comorbidities, shorter operation times, and fewer perioperative transfusions were found in neurosurgery patients. However, many specialty differences found in spinal patients become less pronounced when considering only ASA-1 patients with fewer comorbidities. This preliminary study lays the groundwork for future exploration and benchmarking of performance in spine surgeries across neurosurgery and orthopedics.