Results of the 2015 Scoliosis Research Society Survey on Single Versus Dual Attending Surgeon Approach for Adult Spinal Deformity Surgery

Study Design. An electronic survey administered to Scoliosis Research Society (SRS) membership. Objective. To characterize surgeon practices and views regarding the use of two attending surgeons for adult spinal deformity (ASD) surgery. Summary of Background Data. The use of two experienced attending surgeons can decrease the operative time, estimated blood loss, and perioperative complication rates. However, the current practice patterns for the use of two attending surgeons remains unknown. Methods. An electronic, 27-question survey regarding single/dual attending surgeons was administered to the SRS membership. Determinants included: surgeon/practice demographics, assistant type/level of training, and questions regarding use of two attending surgeons. Overall reporting and comparisons between groups were made: US versus international, academic versus private practice, and experience <15 years versus >15 years. Results. A total of 199 surgeons responded from 27 different countries. Overall and between the groups, the respondents significantly reported believing that two attending spine surgeons improves safety, decreases complications, and improves outcomes (P<0.01). Approximately, 67.3% reported using a second attending <= 25% of the time (33.2% do not), and 24.1% use one > 51% of the time (similar between groups); 51.1% that have a second attending feel it's limited by reimbursement and access concerns and 71.9% have difficulty getting the second attending reimbursed. 72.3% use a second attending for ALL of the following reasons (no difference between groups): "it's safer/reduces complications,'' "it decreases operative time,'' "it decreases blood loss,'' "it results in improved outcomes,'' "it's less work and stress for me.'' If reimbursement was equal/assured for a second attending, 67.5% would use one "more often'' or "always.'' Conclusion. The respondents feel that having a second attending surgeon improves patient care, however most do not use one often. Reasons include reimbursement/access concerns and the majority would use one if reimbursement was equal and assured. Based on the current literature and these results, there is a need for working with third party payers to improve dual surgeon reimbursement rates in complex cases.