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Terry D Amaral - One of the best experts on this subject based on the ideXlab platform.

  • a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume Surgeons have better outcomes with a dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. Level II.

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients
    Spine Deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) ( n  = 302), dual-junior Surgeons (DJ) ( n  = 73), dual senior–junior (SJ) ( n  = 36), dual-senior (DS) ( n  = 21) and a single senior, standard-Volume Surgeon alone (S2) ( n  = 87). Radiographic parameters were similar between the groups ( p  > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 ( p  = 0.034) Pre- and post-op kyphosis were similar ( p  > 0.05). Cobb correction was similar ( p  > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar ( p  > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar ( p  > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter ( p  

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients.
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p 

  • p100 a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Yungtai Lo, Aaron M Atlas, Sayyida S Hasan, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single Surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single vs dual Surgeons, Surgeon experience ( 10 years in practice), and surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. The five cohorts were a single senior High Volume (S1) (n=302), dual-junior Surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume Surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior Surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume Surgeons have better outcomes with dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

  • 134. Surgeon Volume affects short- and long-term surgical outcomes in idiopathic scoliosis
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Aaron M Atlas, Sayyida S Hasan, Alexander M. Satin, Dean C. Perfetti, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Spinal deformity surgery requires the completion of numerous complex tasks. Proper placement of pedicle screws, deformity correction and arthrodesis are learned skills that require significant training and repetition. Surgeon and hospital Volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. There is limited literature regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal defomity correction. One prior report found lower-Volume Surgeons to have Higher perioperative complications, length-of-stay and hospital charges when performing spinal arthrodesis in adolescents with scoliosis. However, the study included all types of scoliosis procedures (idiopathic, neuromuscular and congenital) and was limited to the primary hospital stay. As a result, there is a lack of information regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal deformity surgery. PURPOSE Identify average annual Surgeon Volume for long-segment (>4 vertebrae) pediatric spinal fusions that corresponds to improved short- and long-term outcomes in idiopathic scoliosis surgery. STUDY DESIGN/SETTING New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database Retrospective Review from 2004-2015. PATIENT SAMPLE Pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. International Classification of Diseases, Ninth Revision (ICD-9) were used to extract the index fusion procedure (ICD-9:81.00-81.09), diagnosis (ICD-9:737.30), and to identify patient demographics, reoperation procedures and reoperation diagnoses. OUTCOME MEASURES Number of medium length (4-8 vertebrae) fusions, patient length-of-stay, surgical complications, readmission rates within one year, revision surgery (if any) at 5 and 10 years, hardware malfunction (if any). METHODS We analyzed the SPARCS inpatient database from 2004 to 2015 to identify pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High-Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. ICD-9 codes were used to extract the index fusion procedure (ICD-9:81.00-91.09), diagnosis (ICD-9:737.30) and to identify patient demographics, reoperation procedures and reoperation diagnoses. Patients with a diagnosis of idiopathic scoliosis (noninfantile) were longitudinally folllowed until September 2015, corresponding to a minimum two-year postsurgical follow-up, to determine the incidence of short- and long-term complications. Multivariate analyses were used to identify the odds of complication or revision. RESULTS A total of 3,910 pediatric patients underwent a primary arthrodesis of 4 or more vertebrae from January 2004 to September 2013. A total of 223 Surgeons performed at least one medium- or long-segment fusion over the study duration. The High-Volume Surgeon category was composed of 13 Surgeons (5.8%) who performed 52.9% (2067) of all fusion procedures during the study period. High-Volume Surgeons averaged greater than 15 cases per year over the study duration, with a one-year maximum of 51 cases. High-Volume Surgeons performed more medium-length fusions than low-Volume Surgeons (36.9% vs 32.9%, p = 0.009). High Volume Surgeons experienced shorter lengths-of-stay (5.3 days vs 5.9 days, p CONCLUSIONS High-Volume Surgeons experienced decreased odds of short- and long-term complications compared to their low-Volume colleagues when performing primary spinal arthrodesis in pediatric patients with idiopathic scoliosis. Low-Volume Surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long term follow-up with a significantly increased risk of hardware malfunction at 10 years postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Vishal Sarwahi - One of the best experts on this subject based on the ideXlab platform.

  • a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume Surgeons have better outcomes with a dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. Level II.

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients
    Spine Deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) ( n  = 302), dual-junior Surgeons (DJ) ( n  = 73), dual senior–junior (SJ) ( n  = 36), dual-senior (DS) ( n  = 21) and a single senior, standard-Volume Surgeon alone (S2) ( n  = 87). Radiographic parameters were similar between the groups ( p  > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 ( p  = 0.034) Pre- and post-op kyphosis were similar ( p  > 0.05). Cobb correction was similar ( p  > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar ( p  > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar ( p  > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter ( p  

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients.
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p 

  • p100 a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Yungtai Lo, Aaron M Atlas, Sayyida S Hasan, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single Surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single vs dual Surgeons, Surgeon experience ( 10 years in practice), and surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. The five cohorts were a single senior High Volume (S1) (n=302), dual-junior Surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume Surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior Surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume Surgeons have better outcomes with dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

  • 134. Surgeon Volume affects short- and long-term surgical outcomes in idiopathic scoliosis
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Aaron M Atlas, Sayyida S Hasan, Alexander M. Satin, Dean C. Perfetti, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Spinal deformity surgery requires the completion of numerous complex tasks. Proper placement of pedicle screws, deformity correction and arthrodesis are learned skills that require significant training and repetition. Surgeon and hospital Volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. There is limited literature regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal defomity correction. One prior report found lower-Volume Surgeons to have Higher perioperative complications, length-of-stay and hospital charges when performing spinal arthrodesis in adolescents with scoliosis. However, the study included all types of scoliosis procedures (idiopathic, neuromuscular and congenital) and was limited to the primary hospital stay. As a result, there is a lack of information regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal deformity surgery. PURPOSE Identify average annual Surgeon Volume for long-segment (>4 vertebrae) pediatric spinal fusions that corresponds to improved short- and long-term outcomes in idiopathic scoliosis surgery. STUDY DESIGN/SETTING New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database Retrospective Review from 2004-2015. PATIENT SAMPLE Pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. International Classification of Diseases, Ninth Revision (ICD-9) were used to extract the index fusion procedure (ICD-9:81.00-81.09), diagnosis (ICD-9:737.30), and to identify patient demographics, reoperation procedures and reoperation diagnoses. OUTCOME MEASURES Number of medium length (4-8 vertebrae) fusions, patient length-of-stay, surgical complications, readmission rates within one year, revision surgery (if any) at 5 and 10 years, hardware malfunction (if any). METHODS We analyzed the SPARCS inpatient database from 2004 to 2015 to identify pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High-Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. ICD-9 codes were used to extract the index fusion procedure (ICD-9:81.00-91.09), diagnosis (ICD-9:737.30) and to identify patient demographics, reoperation procedures and reoperation diagnoses. Patients with a diagnosis of idiopathic scoliosis (noninfantile) were longitudinally folllowed until September 2015, corresponding to a minimum two-year postsurgical follow-up, to determine the incidence of short- and long-term complications. Multivariate analyses were used to identify the odds of complication or revision. RESULTS A total of 3,910 pediatric patients underwent a primary arthrodesis of 4 or more vertebrae from January 2004 to September 2013. A total of 223 Surgeons performed at least one medium- or long-segment fusion over the study duration. The High-Volume Surgeon category was composed of 13 Surgeons (5.8%) who performed 52.9% (2067) of all fusion procedures during the study period. High-Volume Surgeons averaged greater than 15 cases per year over the study duration, with a one-year maximum of 51 cases. High-Volume Surgeons performed more medium-length fusions than low-Volume Surgeons (36.9% vs 32.9%, p = 0.009). High Volume Surgeons experienced shorter lengths-of-stay (5.3 days vs 5.9 days, p CONCLUSIONS High-Volume Surgeons experienced decreased odds of short- and long-term complications compared to their low-Volume colleagues when performing primary spinal arthrodesis in pediatric patients with idiopathic scoliosis. Low-Volume Surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long term follow-up with a significantly increased risk of hardware malfunction at 10 years postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Jesse M Galina - One of the best experts on this subject based on the ideXlab platform.

  • a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume Surgeons have better outcomes with a dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. Level II.

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients
    Spine Deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) ( n  = 302), dual-junior Surgeons (DJ) ( n  = 73), dual senior–junior (SJ) ( n  = 36), dual-senior (DS) ( n  = 21) and a single senior, standard-Volume Surgeon alone (S2) ( n  = 87). Radiographic parameters were similar between the groups ( p  > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 ( p  = 0.034) Pre- and post-op kyphosis were similar ( p  > 0.05). Cobb correction was similar ( p  > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar ( p  > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar ( p  > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter ( p  

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients.
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p 

  • p100 a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Yungtai Lo, Aaron M Atlas, Sayyida S Hasan, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single Surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single vs dual Surgeons, Surgeon experience ( 10 years in practice), and surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. The five cohorts were a single senior High Volume (S1) (n=302), dual-junior Surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume Surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior Surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume Surgeons have better outcomes with dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

  • 134. Surgeon Volume affects short- and long-term surgical outcomes in idiopathic scoliosis
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Aaron M Atlas, Sayyida S Hasan, Alexander M. Satin, Dean C. Perfetti, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Spinal deformity surgery requires the completion of numerous complex tasks. Proper placement of pedicle screws, deformity correction and arthrodesis are learned skills that require significant training and repetition. Surgeon and hospital Volume have been shown to correlate with outcomes following cervical and lumbar spine surgery. There is limited literature regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal defomity correction. One prior report found lower-Volume Surgeons to have Higher perioperative complications, length-of-stay and hospital charges when performing spinal arthrodesis in adolescents with scoliosis. However, the study included all types of scoliosis procedures (idiopathic, neuromuscular and congenital) and was limited to the primary hospital stay. As a result, there is a lack of information regarding the impact of Surgeon Volume on long-term outcomes following pediatric idiopathic spinal deformity surgery. PURPOSE Identify average annual Surgeon Volume for long-segment (>4 vertebrae) pediatric spinal fusions that corresponds to improved short- and long-term outcomes in idiopathic scoliosis surgery. STUDY DESIGN/SETTING New York Statewide Planning and Research Cooperative System (SPARCS) Inpatient Database Retrospective Review from 2004-2015. PATIENT SAMPLE Pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. International Classification of Diseases, Ninth Revision (ICD-9) were used to extract the index fusion procedure (ICD-9:81.00-81.09), diagnosis (ICD-9:737.30), and to identify patient demographics, reoperation procedures and reoperation diagnoses. OUTCOME MEASURES Number of medium length (4-8 vertebrae) fusions, patient length-of-stay, surgical complications, readmission rates within one year, revision surgery (if any) at 5 and 10 years, hardware malfunction (if any). METHODS We analyzed the SPARCS inpatient database from 2004 to 2015 to identify pediatric patients (18 years or younger) who underwent primary spinal arthrodesis procedures. Patients with fusion lengths less than 4 vertebrae were excluded. Surgeon Volume was stratified into High- and low-Volume Surgeons, with High-Volume Surgeons representing the top 5% of Surgeons performing primary pediatric spinal arthrodesis (all diagnoses) cases per year over the study duration. These High-Volume Surgeons performed greater than 15 long-segment pediatric spinal fusions per year. ICD-9 codes were used to extract the index fusion procedure (ICD-9:81.00-91.09), diagnosis (ICD-9:737.30) and to identify patient demographics, reoperation procedures and reoperation diagnoses. Patients with a diagnosis of idiopathic scoliosis (noninfantile) were longitudinally folllowed until September 2015, corresponding to a minimum two-year postsurgical follow-up, to determine the incidence of short- and long-term complications. Multivariate analyses were used to identify the odds of complication or revision. RESULTS A total of 3,910 pediatric patients underwent a primary arthrodesis of 4 or more vertebrae from January 2004 to September 2013. A total of 223 Surgeons performed at least one medium- or long-segment fusion over the study duration. The High-Volume Surgeon category was composed of 13 Surgeons (5.8%) who performed 52.9% (2067) of all fusion procedures during the study period. High-Volume Surgeons averaged greater than 15 cases per year over the study duration, with a one-year maximum of 51 cases. High-Volume Surgeons performed more medium-length fusions than low-Volume Surgeons (36.9% vs 32.9%, p = 0.009). High Volume Surgeons experienced shorter lengths-of-stay (5.3 days vs 5.9 days, p CONCLUSIONS High-Volume Surgeons experienced decreased odds of short- and long-term complications compared to their low-Volume colleagues when performing primary spinal arthrodesis in pediatric patients with idiopathic scoliosis. Low-Volume Surgeons experienced significantly greater odds of inpatient surgical complications, as well as increased risk of revision during long term follow-up with a significantly increased risk of hardware malfunction at 10 years postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Yungtai Lo - One of the best experts on this subject based on the ideXlab platform.

  • a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume Surgeons have better outcomes with a dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. Level II.

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients
    Spine Deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) ( n  = 302), dual-junior Surgeons (DJ) ( n  = 73), dual senior–junior (SJ) ( n  = 36), dual-senior (DS) ( n  = 21) and a single senior, standard-Volume Surgeon alone (S2) ( n  = 87). Radiographic parameters were similar between the groups ( p  > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 ( p  = 0.034) Pre- and post-op kyphosis were similar ( p  > 0.05). Cobb correction was similar ( p  > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar ( p  > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar ( p  > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter ( p  

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients.
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p 

  • p100 a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    The Spine Journal, 2019
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Yungtai Lo, Aaron M Atlas, Sayyida S Hasan, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely just as important. PURPOSE This study seeks to evaluate effect of the dual versus single Surgeon approach to Adolescent Idiopathic Scoliosis (AIS) correction through posterior spinal fusion (PSF). STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE AIS patients undergoing PSF from 2012-2018 were included. OUTCOME MEASURES Patient demographics, pre- and postoperative kyphosis, pre- and postoperative Cobb angle, surgery time, anesthesia time, EBL, extubation, transfusion rate, perioperative complication rate, length of hospital stay. METHODS AIS patients undergoing PSF from 2012-2018 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single vs dual Surgeons, Surgeon experience ( 10 years in practice), and surgical Volume ( 50 cases/year). A sub-analysis was performed for adolescent idiopathic scoliosis patients. Median and IQR values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 520 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. The five cohorts were a single senior High Volume (S1) (n=302), dual-junior Surgeons (DJ) (n=73), dual senior-junior (SJ) (n=36), dual-senior (DS) (n=21) and a single senior, standard Volume Surgeon alone (n =87). Radiographic parameters were similar between the groups (p 0.05). S1 had significantly lower EBL (p 0.05) in EBL, operative time, immediate extubation, transfusion rate, perioperative complication rate, and length of hospital stay between SSHV and DS. A dual junior Surgeon approach had significantly shorter anesthesia (p CONCLUSIONS Standard Volume Surgeons have better outcomes with dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

  • Saturday, September 29, 2018 9:00 am–10:00 am Impact of Adult Deformity Correction: 260. The surgical Volume, more than the number of Surgeons or Surgeon experience, drives patient outcomes in pediatric scoliosis
    The Spine Journal, 2018
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Yungtai Lo, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely as important. Our hypothesis is that a Highly experienced and/or High Volume Surgeon does not benefit from a dual Surgeon approach. PURPOSE This study seeks to evaluate effect of surgical Volume, Surgeon experience, and number of Surgeons for spine deformity correction through posterior spinal fusion. STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE Posterior spinal fusion for all spinal deformity patients from 2012 to 2017. OUTCOME MEASURES Estimated blood loss, surgical time, anesthesia time, levels fused, Cobb angle, kyphosis, coronal balance, sagittal balance. METHODS All pediatric spinal deformity patients undergoing spinal deformity Surgeon from 2012 to 2017 were included. Patient demographics, XR and perioperative parameters were collected. Surgical cases were collated based on primary Surgeon. Analysis was performed for single versus dual attending Surgeons, surgical experience ( 10 years), and surgical Volume ( 70 cases/year). Median values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 260 cases, performed by four attendings, had complete records. Two Surgeons were Highly experienced, one of whom is also High Volume. The four cohorts were a Highly experienced or High Volume Surgeon operating alone (n=91), two junior Surgeons (n=80), a Highly experienced Surgeon with a junior Surgeon (n=30), and the Highly experience and High Volume Surgeon together (n=26). Preopeartive Cobb (p=.13), kyphosis (p=.61), coronal balance (p=.75) were similar between the groups. Sagittal balance was significantly Higher for the Highly experienced and High Volume Surgeon group (p=.011). The High Volume Surgeon had significantly lower EBL (475 vs. 600 vs. 700 vs. 400cc, p CONCLUSIONS High Volume Surgeons have better outcomes than dual Surgeons, irrespective of the experience of the dual Surgeons. High Volume Surgeons do not benefit from the addition of a second Surgeon. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Stephen Wendolowski - One of the best experts on this subject based on the ideXlab platform.

  • a dual team approach benefits standard Volume Surgeons but has minimal impact on outcomes for a High Volume Surgeon in ais patients
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p < 0.05). Additionally, DJ had significantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Standard-Volume Surgeons have better outcomes with a dual Surgeon approach. Junior Surgeons benefit operating with an experienced Surgeon. A High-Volume Surgeon, however, does not benefit from a dual Surgeon approach. Level II.

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients
    Spine Deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) ( n  = 302), dual-junior Surgeons (DJ) ( n  = 73), dual senior–junior (SJ) ( n  = 36), dual-senior (DS) ( n  = 21) and a single senior, standard-Volume Surgeon alone (S2) ( n  = 87). Radiographic parameters were similar between the groups ( p  > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 ( p  = 0.034) Pre- and post-op kyphosis were similar ( p  > 0.05). Cobb correction was similar ( p  > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar ( p  > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar ( p  > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter ( p  

  • A dual-team approach benefits standard-Volume Surgeons, but has minimal impact on outcomes for a High-Volume Surgeon in AIS patients.
    Spine deformity, 2020
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Marina Moguilevich, Chhavi Katyal, Beverly Thornhill, Yungtai Lo, Terry D Amaral
    Abstract:

    Retrospective chart review of prospectively collected data. This study seeks to evaluate the effect of number of Surgeons, Surgeon experience, and Surgeon Volume on AIS surgery. Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon’s experience and surgical Volume are likely as important. AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary Surgeon. Analysis was performed for single versus dual Surgeons, Surgeon experience (≤ 10 years in practice), and surgical Volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. 519 AIS cases, performed by 4 Surgeons were included. Two Surgeons were Highly experienced, 1 of whom was also High Volume. Five cohorts were studied: a single senior High Volume (S1) (n = 302), dual-junior Surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-Volume Surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was significantly Higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fixation points, anesthesia and surgical times were similar (p > 0.05). When the standard-Volume Surgeon operated with a second Surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were significantly shorter (p 

  • Saturday, September 29, 2018 9:00 am–10:00 am Impact of Adult Deformity Correction: 260. The surgical Volume, more than the number of Surgeons or Surgeon experience, drives patient outcomes in pediatric scoliosis
    The Spine Journal, 2018
    Co-Authors: Vishal Sarwahi, Jesse M Galina, Stephen Wendolowski, Jonpaul Dimauro, Yungtai Lo, Terry D Amaral
    Abstract:

    BACKGROUND CONTEXT Recent literature suggests that utilizing two Surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the Surgeon's experience and surgical Volume are likely as important. Our hypothesis is that a Highly experienced and/or High Volume Surgeon does not benefit from a dual Surgeon approach. PURPOSE This study seeks to evaluate effect of surgical Volume, Surgeon experience, and number of Surgeons for spine deformity correction through posterior spinal fusion. STUDY DESIGN/SETTING Ambispective chart review. PATIENT SAMPLE Posterior spinal fusion for all spinal deformity patients from 2012 to 2017. OUTCOME MEASURES Estimated blood loss, surgical time, anesthesia time, levels fused, Cobb angle, kyphosis, coronal balance, sagittal balance. METHODS All pediatric spinal deformity patients undergoing spinal deformity Surgeon from 2012 to 2017 were included. Patient demographics, XR and perioperative parameters were collected. Surgical cases were collated based on primary Surgeon. Analysis was performed for single versus dual attending Surgeons, surgical experience ( 10 years), and surgical Volume ( 70 cases/year). Median values, Wilcoxon Rank Sums test, Kruskal-Wallis test, and Fisher's exact test were utilized. RESULTS A total of 260 cases, performed by four attendings, had complete records. Two Surgeons were Highly experienced, one of whom is also High Volume. The four cohorts were a Highly experienced or High Volume Surgeon operating alone (n=91), two junior Surgeons (n=80), a Highly experienced Surgeon with a junior Surgeon (n=30), and the Highly experience and High Volume Surgeon together (n=26). Preopeartive Cobb (p=.13), kyphosis (p=.61), coronal balance (p=.75) were similar between the groups. Sagittal balance was significantly Higher for the Highly experienced and High Volume Surgeon group (p=.011). The High Volume Surgeon had significantly lower EBL (475 vs. 600 vs. 700 vs. 400cc, p CONCLUSIONS High Volume Surgeons have better outcomes than dual Surgeons, irrespective of the experience of the dual Surgeons. High Volume Surgeons do not benefit from the addition of a second Surgeon. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.