Complex spinal surgeries with two attending physicians, instead of one, benefit patients

January 18, 2013
Complex spinal surgeries with 2 attending physicians, instead of 1, benefit patients
UCSF neurosurgeon Christopher Ames, MD, left, and orthopedic surgeon Vedat Deviren, MD, work together in the operating room during a spinal surgery. The two have published a study showing the benefits of having two attending surgeons, instead of one, perform these complex procedures. Credit: Susan Merrell/UCSF

Two heads are better than one, as the saying goes – and a new study by a duo at the University of California, San Francisco (UCSF) demonstrates how having two attending surgeons in the operating room during spinal surgeries can benefit patients in multiple ways.

Most spinal surgeries in the United States are performed by teams led by a single attending surgeon – one top-level doctor who has completed medical school, residency and other specialized training.

In 2007, two spinal surgeons in the Departments of and Orthopedic Surgery joined forces and began doing certain complex, high-risk procedures together, and now they have published their findings on the benefits of having them both in the operating room.

"We found very dramatic results," said UCSF neurosurgeon Christopher Ames, MD, who led the study with his co-senior author, Vedat Deviren, MD.

Published this month in the inaugural issue of "Spine Deformity," the official journal of the Scoliosis Research Society, the data show that surgeries with two attending physicians tended to be much shorter, averaging five hours instead of eight. also suffered less , had fewer major complications and enjoyed shorter hospital stays – all of which should help lower , though the UCSF team did not specifically model how much money this approach would save if widely implemented.

The major benefit to patients is more , said Deviren. "There is no way we would go back to how we used to perform these surgeries with single surgeons," he said.

Spinal Surgery: 2 Surgeons Vs. One Credit: Kevin Eisenmann/UCSF

A Complex Surgery for Scoliosis

The idea to have multiple attending surgeons perform complicated surgeries is not new to medicine. Many complicated procedures that fall under other specialties, such as , are performed in this way. But the UCSF research was the first study to demonstrate the effectiveness of the approach in spinal surgeries.

The particular complex procedure considered in the study is called a pedicle subtraction osteotomy, a surgery that realigns the spine in cases of very severe deformities, many of which arise from alignment complications of prior surgery and severe degenerative spinal arthritis.

Adult spinal deformity is becoming more common as the baby boomer population ages, as is the demand for the corrective surgery, said Ames. "Older adults are demanding higher levels of function as they get older," he said.

The video will load shortly
Two heads are better than one, as the saying goes -- and a new study by a duo at the University of California, San Francisco (UCSF) demonstrates how having two attending surgeons in the operating room during spinal surgeries can benefit patients in multiple ways. Credit: Jason Socrates Bardi/UCSF

UCSF has top-ranking programs in both neurological and orthopedic surgery and is a referral center for particularly complex, high-risk spinal surgeries. Surgeons at UCSF currently perform over 75 such operations every year – many on older patients who may have osteoporosis, heart problems and other age-related issues that make the surgeries even more complicated.

After they began collaborating five years ago, Ames and Deviren became convinced that working together had a positive impact on their patients, but they wanted to quantify how much. They compared 42 patients who underwent the surgery at UCSF with a single surgeon, versus 36 patients who had the same procedures under the care of two attending surgeons.

They found that in addition to spending less time in the operating room, patients in the group with two surgeons suffered half as much blood loss on average during and were much less likely to have major complications or unplanned additional surgeries within a month of their original operation.

For Ames and Deviren, these tangible benefits are fundamentally no different from those that patients might reap by using a new drug or some other clinical intervention. The bottom line, Ames said, is that the data suggests having two attending doctors is better and safer.

"If you had a drug or device that would result in this kind of improvement in treatment , of course you would give those to your patients," he said.

Explore further: Surgeon experience affects complication rate of spinal stenosis surgery

More information: The article, "Perioperative Outcomes and Complications of Pedicle Subtraction Osteotomy in Cases With Single Versus Two Attending Surgeons" is authored by Christopher P. Ames, Jeffrey J. Barry, Sassan Keshavarzi, Ozgur Dede, Michael H. Weber and Vedat Deviren. It was published online by the journal "Circulation" on Dec. 28, 2012. See: www.spine-deformity.org/articl … 2%2900034-2/abstract

Related Stories

Surgeon experience affects complication rate of spinal stenosis surgery

June 7, 2012
For patients undergoing surgery for spinal stenosis, the risk of complications is higher when the surgeon performs very few such procedures—less than four per year, suggests a study in the June issue of Neurosurgery, ...

Spinal surgeries more successful than reflected in public reported statistics: UCSF

April 17, 2012
The odds that someone undergoing spinal surgery at a particular hospital will have to be readmitted to the same hospital within 30 days is an important measure of the quality of care patients receive. That's because these ...

Guideline: Monitoring spinal cord during surgery may help prevent paralysis

February 20, 2012
The American Academy of Neurology is issuing an updated guideline that recommends monitoring the spinal cord during spinal surgery and certain chest surgeries to help prevent paralysis, or loss of muscle function, related ...

Minimally invasive spine surgery using real-time 3-D CT imaging allows patients to recover more quickly

January 15, 2013
(Medical Xpress)—With demand for unresolved back pain relief growing as the U.S. population ages, Rush University Medical Center is doing more minimally invasive spine surgery procedures that allow patients to return to ...

UCSF analysis shows newer surgery for neck pain may be better

April 11, 2011
A new surgery for cervical disc disease in the neck may restore range of motion and reduce repeat surgeries in some younger patients, according to a team of neurosurgeons from the University of California, San Francisco (UCSF) ...

Surgery consultation common after MRI of the spine

January 2, 2013
(HealthDay)—Almost half of patients whose primary care physicians recommend a lumbosacral or cervical spine magnetic resonance imaging (MRI) scan go on to receive a surgical consultation, but few end up undergoing spinal ...

Recommended for you

World's first child hand transplant a 'success'

July 19, 2017
The first child in the world to undergo a double hand transplant is now able to write, feed and dress himself, doctors said Tuesday, declaring the ground-breaking operation a success after 18 months.

Knee surgery—have we been doing it wrong?

July 18, 2017
A team of University at Buffalo medical doctors have published a study that challenges a surgical practice used for decades during arthroscopic knee surgery.

New tools help surgeons find liver tumors, not nick blood vessels

July 17, 2017
The liver is a particularly squishy, slippery organ, prone to shifting both deadly tumors and life-preserving blood vessels by inches between the time they're discovered on a CT scan and when the patient is lying on an operating ...

Researchers discover indicator of lung transplant rejection

July 13, 2017
Research by scientists at Dignity Health St. Joseph's Hospital and Medical Center's Norton Thoracic Institute was published in the July 12, 2017 issue of Science Translational Medicine titled "Zbtb7a induction in alveolar ...

New device could make closing surgical incisions a cinch

July 7, 2017
Like many surgeons, Dr. Jason Spector is often faced with the challenge of securely closing the abdominal wall without injuring the intestines. If the process goes awry, there can be serious consequences for patients, including ...

Success with first 20 patients undergoing minimally invasive pancreatic transplant surgery

June 29, 2017
Surgeons at Johns Hopkins Medicine report that their first series of a minimally invasive procedure to treat chronic pancreas disease, known as severe pancreatitis, resulted in shorter hospital stays, less need for opioids ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.