Perioperative outcomes and complications related to teaching residents and fellows in scoliosis surgery

Study Design. Single-surgeon retrospective case series of 303 consecutive operative patients with idiopathic scoliosis (IS). Objective. The purpose of this study is to evaluate the perioperative outcomes in patients undergoing surgery for IS as a function of the experience level of the surgical assistant. Summary of Background Data. The experience level of the surgical assistant, who is often a resident or fellow, has never before been evaluated as an independent factor in predicting perioperative outcomes and morbidity in scoliosis surgery. We hypothesize that there is no difference in perioperative outcomes with varying experience level of the surgical assistant. Methods. We evaluated the clinical, radiographic, and operative records from 303 consecutive operative patients from consecutive patients with IS. Group I was comprised of residents or spine fellows as assistants (teaching service, n = 175), and Group II consisted of junior or senior attendings as assistants (private practice service, n = 128). Multivariable linear regression was used to evaluate the relationship between experience level of the assistant and curve correction, operative time, estimated blood loss (EBL), complications, transfusions, and length of stay. Results. In the posterior spinal fusion group (PSF, n = 164), there were no statistically significant differences in operative times between Groups I and II. Group I operative time was significantly increased, however, in patients undergoing anterior spinal surgery (ASF, P = 0.01), video-assisted thoracoscopic surgery (P = 0.0004), and combined anterior/posterior surgeries (ASF/PSF, P = 0.0063). There were no differences in EBL in ASF, video-assisted thoracoscopic surgery, or PSF surgeries, however, Group I had significantly higher EBL in the ASF/PSF group (P = 0.0016). No group differences were detected with respect to curve correction, transfusion rates, length of stay, or early complication rates. Conclusion. The experience level of surgical assistant had little bearing on perioperative morbidity or radiographic outcomes in scoliosis surgery. Marginally increased operative times and EBL, without an increase in transfusions or complications, is an acceptably safe tradeoff for educating orthopedic residents and fellows.