TY - JOUR
T1 - Single-event multilevel surgery in cerebral palsy
T2 - Value added by a co-surgeon
AU - Nahm, Nickolas J.
AU - Ludwig, Meryl
AU - Thompson, Rachel
AU - Rogers, Kenneth J.
AU - Imerci, Ahmet
AU - Dabney, Kirk W.
AU - Miller, Freeman
AU - Sees, Julieanne P.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/6/18
Y1 - 2021/6/18
N2 - The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons (P=0.03). Decreased operative time was associated with an estimated savings of 2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P=0.11). Decreased operative time was associated with an estimated savings of 1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III Abbreviations: CP = cerebral palsy, GMFCS = Gross Motor Function Classification System, OR = operating room, SEMLS = single-event multilevel surgery.
AB - The aim of this study was to compare outcomes for single-event multilevel surgery (SEMLS) in cerebral palsy (CP) performed by 1 or 2 attending surgeons. A retrospective review of patients with CP undergoing SEMLS was performed. Patients undergoing SEMLS performed by a single senior surgeon were compared with patients undergoing SEMLS by the same senior surgeon and a consistent second attending surgeon. Due to heterogeneity of the type and quantity of SEMLS procedures included in this study, a scoring system was utilized to stratify patients to low and high surgical burden. The SEMLS events scoring less than 18 points were categorized as low burden surgery and SEMLS scoring 18 or more points were categorized as high burden surgery. Operative time, estimated blood loss, hospital length of stay, and operating room (OR) utilization costs were compared. In low burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 8 patients had SEMLS performed by 2 surgeons. In high burden SEMLS, 10 patients had SEMLS performed by a single surgeon and 12 patients had SEMLS performed by 2 surgeons. For high burden SEMLS, operative time was decreased by a mean of 69 minutes in cases performed by 2 co-surgeons (P=0.03). Decreased operative time was associated with an estimated savings of 2484 per SEMLS case. In low burden SEMLS, a trend toward decreased operative time was associated for cases performed by 2 co-surgeons (182 vs 221 minutes, P=0.11). Decreased operative time was associated with an estimated savings of 1404 per low burden SEMLS case. No difference was found for estimated blood loss or hospital length of stay between groups in high and low burden SEMLS. Employing 2 attending surgeons in SEMLS decreased operative time and OR utilization cost, particularly in patients with a high surgical burden. These findings support the practice of utilizing 2 attending surgeons for SEMLS in patients with CP. Level of Evidence: Level III Abbreviations: CP = cerebral palsy, GMFCS = Gross Motor Function Classification System, OR = operating room, SEMLS = single-event multilevel surgery.
KW - cerebral palsy
KW - co-surgeon
KW - lower extremity osteotomy
KW - single-event multilevel surgery
UR - http://www.scopus.com/inward/record.url?scp=85108387014&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108387014&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000026294
DO - 10.1097/MD.0000000000026294
M3 - Article
C2 - 34128865
AN - SCOPUS:85108387014
SN - 0025-7974
VL - 100
SP - E26294
JO - Medicine (United States)
JF - Medicine (United States)
IS - 24
ER -