Two AIS spine surgeries on the same day by the same surgeon: is performance and outcome the same for the second patient?
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Two AIS spine surgeries on the same day by the same surgeon: is performance and outcome the same for the second patient? Lorena V. Floccari1,2 · Kiley F. Poppino2 · Surya N. Mundluru2,3 · Amy L. McIntosh2 · Karl E. Rathjen2 · Daniel J. Sucato2 Received: 31 December 2019 / Accepted: 11 May 2020 © Scoliosis Research Society 2020
Abstract Study design Retrospective case-controlled study. Objectives To analyze the overall performance and outcome of two-a-day surgery days for adolescent idiopathic scoliosis (AIS). Summary of background data As a method to improve efficiency and operating room utilization, some surgeons are now performing two surgeries for AIS in a single day. Methods A prospectively collected series of AIS patients who underwent posterior spinal fusion on the same day as a second AIS patient by the same surgeon and surgical team were retrospectively reviewed. Patients who underwent same-day surgery (SD) were grouped according to whether they were the first (SD1) or second (SD2) case of the day and were matched (M1 and M2) by surgeon, curve magnitude, Lenke classification, and fusion levels. Comparisons were made: SD1 vs. SD2, SD1 vs. M1, and SD2 vs. M2. Results There were 56 patients, with no differences between groups in age, gender, BMI, or curve magnitude (66° vs. 62° vs. 65° vs. 63°). Surgical time was shorter for the SD1 group (17.2 min/level) compared to M1 (20.5 min/level) for a 15% operative time reduction of 44 min (p = 0.008). There were no differences between the groups in curve correction (65.8% vs. 62.8% vs. 66.1% vs. 58.5%), estimated blood loss (EBL), length of stay, or complication rate. One SD2 patient had a malpositioned screw that required revision. There were no other complications. Conclusions When performing two AIS surgeries on the same day, surgical time was reduced by 44 min, or 15%, on the first case compared to a matched control. This may be a reflection of the team moving along more efficiently, given the full operative day scheduled. The performance measures of curve correction, EBL, complications, and length of stay did not decline in this new model, and no increased incidence of complications was seen. Keywords Adolescent idiopathic scoliosis · AIS · Spinal deformity · Practice management
Introduction In the current health-care environment, there is increased attention on improving surgical efficiency to provide highvolume, low-cost health care while maintaining high-quality * Daniel J. Sucato [email protected] 1
Akron Children’s Hospital, Akron, OH, USA
2
Texas Scottish Rite Hospital for Children, University of Texas Southwestern Medical Center, 2222 Welborn St., Dallas, TX 75219, USA
3
University of Texas Houston McGovern School of Medicine, Houston, TX, USA
patient care. If value is defined as cost per unit outcome, it may be that performing two AIS surgeries on the same day is of high value. Efficacious use of hospital resources, including operating room time and personnel, is vital for hospital sustainability and minimizing cost
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