Study Design: 

The present study design was that of a single center, retrospective cohort study to evaluate the influence of surgeon-specific factors on patient functional outcomes at 6 months following lumbar fusion. Retrospective review of a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis identified the present study population.

Objective: 

This study seeks to evaluate surgeon-specific variable effects on patient-reported outcomes such as Oswestry Disability Index (ODI) and the effect of North American Spine Society (NASS) concordance on outcomes in the setting of variable surgeon characteristics.

Summary of Background Data: 

Lumbar fusion is one of the fastest growing procedures performed in the United States. Although the impact of surgeon-specific factors on patient-reported outcomes has been contested, studies examining these effects are limited.

Methods: 

This is a single center, retrospective cohort study analyzing a prospectively maintained database of patients who underwent neurosurgical lumbar instrumented arthrodesis by 1 of 5 neurosurgery fellowship trained spine surgeons. The primary outcome was improvement of ODI at 6 months postoperative follow-up compared with preoperative ODI.

Results: 

A total of 307 patients were identified for analysis. Overall, 62% of the study population achieved minimum clinically important difference (MCID) in ODI score at 6 months. Years in practice and volume of lumbar fusions were statistically significant independent predictors of MCID ODI on multivariable logistic regression (P=0.0340 and P=0.0343, respectively). Concordance with evidence-based criteria conferred a 3.16 (95% CI: 1.03, 9.65) times greater odds of achieving MCID.

Conclusion: 

This study demonstrates that traditional surgeon-specific variables predicting surgical morbidity such as experience and procedural volume are also predictors of achieving MCID 6 months postoperatively from lumbar fusion. Independent of surgeon factors, however, adhering to evidence-based guidelines can lead to improved outcomes.

中文翻译：

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增加外科医生的经验和体积与腰椎融合患者临床结果的改善相关

学习规划： 

目前的研究设计是单中心回顾性队列研究，以评估外科医生特定因素对腰椎融合术后 6 个月患者功能结果的影响。对接受神经外科腰椎器械关节固定术的患者的前瞻性维护数据库的回顾性审查确定了目前的研究人群。

客观的： 

本研究旨在评估外科医生特定变量对患者报告结果的影响，例如 Oswestry 残疾指数 (ODI) 和北美脊柱协会 (NASS) 一致性对可变外科医生特征设置结果的影响。

背景数据摘要： 

腰椎融合术是美国发展最快的手术之一。尽管外科医生特定因素对患者报告结果的影响一直存在争议，但检查这些影响的研究是有限的。

方法： 

这是一项单中心、回顾性队列研究，分析了一个前瞻性维护的数据库，该数据库由 5 名受过神经外科专科培训的脊柱外科医生中的 1 名接受神经外科腰椎器械关节固定术的患者组成。主要结果是与术前 ODI 相比，术后 6 个月的 ODI 有所改善。

结果： 

总共确定了 307 名患者进行分析。总体而言，62% 的研究人群在 6 个月时达到 ODI 评分的最小临床重要差异 (MCID)。在多变量逻辑回归中，实践年限和腰椎融合术体积是 MCID ODI 的具有统计学意义的独立预测因子（分别为P = 0.0340 和P = 0.0343）。与基于证据的标准相一致，实现 MCID 的几率高出 3.16（95% CI：1.03，9.65）倍。

结论： 

这项研究表明，预测手术并发症的传统外科医生特定变量（例如经验和手术量）也是腰椎融合术后 6 个月实现 MCID 的预测因素。然而，独立于外科医生因素，坚持循证指南可以改善结果。