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The Effect of the Level of Training of the First Assistant on the Outcomes of Adolescent Idiopathic Scoliosis Surgery

The Effect of the Level of Training of the First Assistant on the Outcomes of Adolescent... Background: At academic medical centers, residents and fellows play an integral role as surgical first assistants in spinal deformity surgery. However, limited data exist on whether the experience level of the surgical assistant affects outcomes. Methods: We conducted a multicenter, multisurgeon study comparing perioperative and postoperative outcomes after adolescent idiopathic scoliosis (AIS) surgery for the same 11 surgeons who performed cases that were assisted by residents compared with cases that were assisted by fellows. Blood loss, operative time, duration of hospitalization, complication rates, Scoliosis Research Society (SRS)-22 questionnaire scores, and radiographic outcomes were compared between the 2 groups. Results: We evaluated outcomes for 347 surgical procedures; 118 cases were assisted by residents and 229 were assisted by fellows. Preoperative radiographic and demographic parameters were not different between the groups. The resident group had significantly more estimated blood loss than the fellow group (939 compared with 762 mL, p = 0.02). Otherwise, the perioperative characteristics were similar between the groups, including the volume of the autologous blood recovery system product that was transfused, the operative time, and the occurrence of intraoperative neuromonitoring changes. Postoperatively, the percentage correction of the Cobb angle, the number of levels that had been fused, the number of days until the discharge criteria had been met, and the rate of major complications were similar between the groups. At the 2-year follow-up, the overall and subdomain SRS-22 questionnaire scores were not different between the groups, except that patients in the resident-assisted group had slightly worse pain scores than those in the fellow-assisted group (4.3 compared with 4.5, p = 0.01). Conclusions: The first assistant’s level of training did not affect clinical or radiographic outcomes following AIS surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 2Shriners Hospitals for Children—Philadelphia, Philadelphia, Pennsylvania 3Rady Children’s Hospital—San Diego, San Diego, California 4Mount Sinai Beth Israel Medical Center, New York, NY 5BC Children’s Hospital, Vancouver, British Columbia, Canada 6Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware Investigation performed at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Disclosure: This study was supported by a research grant from the Setting Scoliosis Straight Foundation in support of the Harms Study Group, of which 8 of the authors (J.M.F., J.M.P., A.F.S., B.Y., B.S.L., F.M., S.A.S., and P.J.C.) are members. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work; “yes” to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work; and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJS/F176). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Journal of Bone & Joint Surgery Wolters Kluwer Health

The Effect of the Level of Training of the First Assistant on the Outcomes of Adolescent Idiopathic Scoliosis Surgery

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References (16)

Publisher
Wolters Kluwer Health
ISSN
0021-9355
eISSN
1535-1386
DOI
10.2106/JBJS.18.00018
Publisher site
See Article on Publisher Site

Abstract

Background: At academic medical centers, residents and fellows play an integral role as surgical first assistants in spinal deformity surgery. However, limited data exist on whether the experience level of the surgical assistant affects outcomes. Methods: We conducted a multicenter, multisurgeon study comparing perioperative and postoperative outcomes after adolescent idiopathic scoliosis (AIS) surgery for the same 11 surgeons who performed cases that were assisted by residents compared with cases that were assisted by fellows. Blood loss, operative time, duration of hospitalization, complication rates, Scoliosis Research Society (SRS)-22 questionnaire scores, and radiographic outcomes were compared between the 2 groups. Results: We evaluated outcomes for 347 surgical procedures; 118 cases were assisted by residents and 229 were assisted by fellows. Preoperative radiographic and demographic parameters were not different between the groups. The resident group had significantly more estimated blood loss than the fellow group (939 compared with 762 mL, p = 0.02). Otherwise, the perioperative characteristics were similar between the groups, including the volume of the autologous blood recovery system product that was transfused, the operative time, and the occurrence of intraoperative neuromonitoring changes. Postoperatively, the percentage correction of the Cobb angle, the number of levels that had been fused, the number of days until the discharge criteria had been met, and the rate of major complications were similar between the groups. At the 2-year follow-up, the overall and subdomain SRS-22 questionnaire scores were not different between the groups, except that patients in the resident-assisted group had slightly worse pain scores than those in the fellow-assisted group (4.3 compared with 4.5, p = 0.01). Conclusions: The first assistant’s level of training did not affect clinical or radiographic outcomes following AIS surgery. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. 1Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 2Shriners Hospitals for Children—Philadelphia, Philadelphia, Pennsylvania 3Rady Children’s Hospital—San Diego, San Diego, California 4Mount Sinai Beth Israel Medical Center, New York, NY 5BC Children’s Hospital, Vancouver, British Columbia, Canada 6Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware Investigation performed at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania Disclosure: This study was supported by a research grant from the Setting Scoliosis Straight Foundation in support of the Harms Study Group, of which 8 of the authors (J.M.F., J.M.P., A.F.S., B.Y., B.S.L., F.M., S.A.S., and P.J.C.) are members. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work; “yes” to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work; and “yes” to indicate that the author had other relationships or activities that could be perceived to influence, or have the potential to influence, what was written in this work (http://links.lww.com/JBJS/F176).

Journal

The Journal of Bone & Joint SurgeryWolters Kluwer Health

Published: Mar 20, 2019

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