Page 18 - Delaware Medical Journal - May/June 2019

Effect of the First Surgical Assistant Level on Surgical Outcome After Spinal Fusion in Cerebral Palsy
Oussama Abousamra, MD; Maria del Pilar Duque Orozco, MD; Kenneth J. Rogers, PhD, ATC; Freeman Miller, MD; Julieanne P. Sees, DO
PURPOSE: The aim of this study was to evaluate posterior spinal fusion (PSF) outcomes for scoliosis in cerebral
palsy (CP) patients based on the level of the first surgical assistant. The surgeon’s experience is an important factor influencing the surgical outcome. However, variable results are reported regarding the impact of the assistant’s level of experience on surgical outcome and complications.
METHODS: This was a retrospective review of CP patients undergoing PSF by the same surgeon at one institution. Preoperative medical comorbidities, intraoperative blood loss, procedure time, curve correction, and postoperative hospital course were recorded. Data were compared between two groups: 1) primary and junior attending surgeon and 2) primary surgeon and fellow or resident.
RESULTS: Between 2011 and 2015, 44 PSFs occurred: group 1 (16) and group 2 (28). No difference in the
preoperative data between groups existed. Longer operative time (246 vs. 288 min; P=0.013), greater blood loss (3225 vs. 2231 mL; P=0.0105), and longer intubation time (3 vs. 1 day; P=0.0014) were found in the second group.
CONCLUSIONS: This study emphasizes the safety of surgical education in scoliosis surgery in patients with cerebral palsy. However, having more experienced assistants with an interest in the procedure as part of their future career in management of neuromuscular disorders has mutual benefits that need to be considered. The experience level of leading surgeons, including experience in teaching assistants in the operating room, is an important factor for evaluation whenever similar studies in different fields of surgery are planned.
KEYWORDS: cerebral palsy, scoliosis, posterior spinal fusion, first assistant, operative time
114 Del Med J | May/June 2019 | Vol. 91 | No. 3
Abstract