Page 19 - Delaware Medical Journal - May/June 2019
P. 19
CASE REPORT
TABLE 1: Demographic, functional, and cerebral palsy comorbidities data for two groups of patients who had spinal fusion based on the first assistant’s level
Leading surgeon + junior attending
16 patients
Leading surgeon + fellow/resident
28 patients
Mean
SD
Mean
SD
P values
Age (years)
14.7
2.7
14.5
3.3
0.855
Weight z-score
-2.8
1.8
-3.7
3.8
0.307
Number
%
Number
%
P values
Males
7
44
18
64
0.176
Females
9
56
10
36
0.176
GMFCS IV
1
6
6
21
0.175
GMFCS V
15
94
22
79
0.175
Seizures
8
50
14
50
>0.99
Gastrostomy tubes
12
75
18
64
0.439
Baclofen pump
4
25
8
29
0.734
Tracheostomy
1
6
1
4
0.638
Vagus nerve stimulation
2
13
1
4
0.245
INTRODUCTION
Surgical training has been the focus
of many research studies that aim to evaluate the impact of surgical residents and fellows training on hospital cost, and more importantly on patient safety.1-6 Although the surgeon’s experience is the surgical outcome, the level of
assess, and variable results are reported regarding the impact of the assistant’s level of experience on surgical outcome and complications. Although teaching residents during surgery is associated with more operative time
in some procedures,1,2 the level of the assistant had little role in others. This variability may be due to the inability
to accurately differentiate the multiple levels of experience and skills between the trainees, in addition to the variability in the leading surgeon’s teaching experience and skills.
Spine surgery, as a complex and demanding surgery with a steep learning curve, is used as a model
to evaluate the safety of surgical education.4 Different levels of experience are compared, and overall, the assistant’s level of experience does outcome after posterior spinal fusion as previously seen in idiopathic scoliosis surgery. In neuromuscular scoliosis surgery, however, shorter operative time and greater curve correction
are reported when fellows assisted in posterior spinal fusion compared with junior residents.9
The aim of this study is to evaluate the outcome after posterior spinal fusion for scoliosis in patients with cerebral surgical assistant. Intraoperative as
GMFCS: gross motor function classification system, SD: standard deviation
well as immediate postoperative data are reported.
METHODS
This study was approved by our Institutional Review Board. Records
of children with cerebral palsy who underwent posterior spinal fusion were reviewed. All reviewed procedures
were performed by the same leading pediatric orthopaedic surgeon at our institution between 2011 and 2015. In all cases, a unit rod with sublaminar wires was used and fusion was performed from T1/T2 to the pelvis. Demographic, clinical, and surgical data were recorded. Gender; age; weight z-score; medical comorbidities including having seizures, dependence on gastrostomy tubes, presence of intrathecal baclofen therapy, tracheostomy, or vagus nerve stimulator were recorded from the
medical charts. General functional status was assessed according to the System (GMFCS).10 Spinal deformity was assessed by measuring the
major coronal curve using the Cobb method.11 Procedure time, blood loss, curve correction, and concomitant procedures were recorded from the operative reports. Length of intubation, length of stay in the pediatric intensive care unit, length of hospital stay,
as well as any complications and reoperations within 90 days after surgery were also recorded.
group, the leading surgeon was assisted by the same junior attending surgeon who was part of the cerebral palsy team at our institution. During the time of this study, the leading surgeon had greater than 25 years of experience
as an attending surgeon, including
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