Variation in Care Among Spinal Deformity Surgeons

Abstract

In Brief Study Design. Survey. Objective. To understand the variation in scoliosis surgery and perioperative care among spinal deformity surgeons. Summary of Background Data. While variation in care has been well described in many spinal disorders, the degree of variation has not been described for spinal deformity. Methods. Clinical histories and radiographs of 4 typical spinal deformity patients were sent to spinal deformity surgeons for review. The cases consisted of idiopathic thoracolumbar, double major, and right thoracic curves and a neuromuscular lumbar curve. The survey queried choice of surgical approach, levels fused and instrumented, type of instrumentation, preoperative testing, intraoperative neurologic monitoring, blood and antibiotic use, and postoperative care, including pain control and patient mobilization. Cost estimates for each case were obtained from the individual hospitals' pricing. Results. There was wide variation in the specific fusion levels and instrumentation for the idiopathic curves. The variation was greatest for the thoracolumbar curve. The double major and right thoracic curves differed primarily in their choice of instrumenting secondary curves. The neuromuscular curve had the least variation. Costs estimates were widely disparate between centers. Perioperative care had much less disparity. Conclusions. Agreement appears common in areas with readily identifiable outcomes such as shorter length of stay and rapid postoperative mobilization. However, agreement is poor in areas where outcomes are difficult to measure and require long-term follow-up such as instrumentation fusion and levels. From a survey of spinal deformity surgeons, spinal deformity surgery shows wide variation in fusion levels, instrumentation, and costs. Perioperative care has less variation in its pattern, although some issues including preoperative imaging, neuromonitoring, and perioperative antibiotic duration have substantial disagreement.