PMID- 34979519
OWN - NLM
STAT- MEDLINE
DCOM- 20220228
LR  - 20230714
IS  - 1940-5480 (Electronic)
IS  - 1067-151X (Linking)
VI  - 30
IP  - 5
DP  - 2022 Mar 1
TI  - Impact of Surgeon Experience on Outcomes of Anterior Cervical Discectomy and 
      Fusion.
PG  - e537-e546
LID - 10.5435/JAAOS-D-21-01080 [doi]
AB  - INTRODUCTION: The relationship between surgeon experience and cervical fusion 
      outcomes has yet to be assessed. We investigate perioperative characteristics, 
      patient-reported outcomes (PROMs), and minimal clinically important difference 
      (MCID) achievement after anterior cervical diskectomy and fusion (ACDF) by the 
      volume of cases done throughout an orthopaedic spine surgeon's career. METHODS: 
      ACDF procedures between 2005 and 2020 were identified. Group I included the first 
      half of ACDF cases (#1-#321). PROMs were introduced in the second half of the 
      ACDF cases; thus, the next 322 cases were subdivided to compare PROM and MCID 
      between subgroups (cases #322 to #483 = group II and #484 to #645 = group III). 
      PROMs, including VAS back/leg, Oswestry Disability Index (ODI), Short Form-12 
      Physical Composite Score, and PROMIS-PF, were collected 
      preoperatively/postoperatively. Demographics, perioperative variables, mean 
      PROMs, and MCID achievement were compared between groups and subgroups using the 
      Student t-test and chi-square. Logistic regression evaluated MCID achievement 
      using the established threshold values. RESULTS: A total of 642 patients were 
      included (320 in group I, 161 in group II, and 161 in group III). The latter 
      cases had significantly decreased surgical time, blood loss, and postoperative 
      length of stay in comparison of groups and subgroups (P </= 0.002, all). 
      CT-confirmed 1-year arthrodesis rates were increased among the latter cases (P = 
      0.045). Group II had significantly higher arthrodesis rates than group III (P = 
      0.039). The postoperative complication rates were lower in the latter cases (P < 
      0.001, all), whereas subgroup analysis revealed lower incidence of urinary 
      retention and other complications in group III (P </= 0.031, all). Mean PROMs were 
      significantly inferior in group II versus group III for VAS neck at 6 months (P = 
      0.030), Neck Disability Index at 6 months preoperatively (P </= 0.022, both), Short 
      Form-12 Physical Composite Score at 12 weeks/2 years (P </= 0.047, both), and 
      PROMIS-PF at 12 weeks/6 months (P </= 0.036, both). The MCID attainment rates were 
      higher among group III for VAS neck/Neck Disability Index at 2 years (P </= 0.005) 
      and overall achievement across all PROMs (P </= 0.015, all). DISCUSSION: Increased 
      ACDF case volume may lead to markedly decreased surgical time, blood loss, and 
      length of postoperative stay as well as improved clinical outcomes in pain, 
      disability, and physical function.
CI  - Copyright (c) 2021 by the American Academy of Orthopaedic Surgeons.
FAU - Patel, Madhav R
AU  - Patel MR
AD  - From the Department of Orthopaedic Surgery, Rush University Medical Center, 
      Chicago, IL.
FAU - Jacob, Kevin C
AU  - Jacob KC
FAU - Shah, Vivek P
AU  - Shah VP
FAU - Pawlowski, Hanna
AU  - Pawlowski H
FAU - Vanjani, Nisheka N
AU  - Vanjani NN
FAU - Prabhu, Michael C
AU  - Prabhu MC
FAU - Singh, Kern
AU  - Singh K
AUID- ORCID: 0000-0002-6118-7273
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Acad Orthop Surg
JT  - The Journal of the American Academy of Orthopaedic Surgeons
JID - 9417468
SB  - IM
MH  - Cervical Vertebrae/surgery
MH  - Diskectomy/adverse effects/methods
MH  - Humans
MH  - Retrospective Studies
MH  - *Spinal Fusion/adverse effects/methods
MH  - *Surgeons
MH  - Treatment Outcome
EDAT- 2022/01/04 06:00
MHDA- 2022/03/01 06:00
CRDT- 2022/01/03 20:29
PHST- 2021/10/25 00:00 [received]
PHST- 2021/12/15 00:00 [accepted]
PHST- 2022/01/04 06:00 [pubmed]
PHST- 2022/03/01 06:00 [medline]
PHST- 2022/01/03 20:29 [entrez]
AID - 00124635-202203010-00012 [pii]
AID - 10.5435/JAAOS-D-21-01080 [doi]
PST - ppublish
SO  - J Am Acad Orthop Surg. 2022 Mar 1;30(5):e537-e546. doi: 10.5435/JAAOS-D-21-01080.