The Impact of Resident and Fellow Involvement in Adult Spinal Deformity Surgery.

BACKGROUND: Adult spinal deformity (ASD) operations are complex and often require a multi-surgeon team. Simultaneously, it is the responsibility of academic spine surgeons to train future complex spine surgeons. Our objective was to assess the impact of resident/fellow involvement (RFI) on ASD surgery in four areas: 1) perioperative outcomes, 2) length of stay (LOS), 3) discharge status, and 4) complications.

METHODS: Adults undergoing thoracolumbar spinal deformity correction between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Cases were divided into those with RFI compared to attending(s) only. The outcomes were: operative time, transfusions, LOS, discharge status, and complications. Univariate and multivariable regression modeling was used. Covariates included preoperative comorbidities, specialty, and levels instrumented.

RESULTS: A total of 1,471 patients underwent ASD surgery with RFI in 784 (53%) operations. After multivariable regression modeling, RFI was independently associated with longer operations (β=66.01 minutes, 95%CI 35.82-96.19, p<0.001), increased odds of transfusion (OR 2.80, 95%CI 1.81-4.32, p<0.001), longer hospital stay (β=1.76 days, 95% CI 0.18-3.34, p=0.030), and discharge to inpatient rehab or skilled nursing facility (OR 2.02, 95% CI 1.34-3.05, p<0.001). However, RFI was not associated with any increase in major or minor complications.

DISCUSSION: RFI in ASD surgery was associated with increased operative time, additional transfusions, longer LOS, and non-home discharge; however, no increase in major, minor, or severe complications was seen. These data support the continued training of future deformity and complex spine surgeons without fear of worsening complications, yet areas of improvement exist.