JAAOS - 2026-03-18 - Journal Article
Isolating the Effect of Surgeon Experience on Spine Surgery Outcomes: A Retrospective Cohort Study Stratified by Procedure Type.
Movva AK, Bennett CF, Hurka KL, Joaquin TA, Patel AA, Divi SN
Topics
Key Takeaway
Each additional year of surgeon experience reduces long-term complication odds in lumbar fusion by 17% (OR 0.83) and PCDF by 29% (OR 0.71), but confers no benefit for ACDF outcomes.
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Summary
This study asked whether surgeon experience independently predicts surgical outcomes across three common spine procedures at a multisite academic center from 2003–2023. Multivariate logistic regression adjusted for age, BMI, sex, race, diagnosis, primary surgeon, and Elixhauser comorbidities. Experience reduced long-term complications in lumbar fusion (OR 0.83, p<0.001) and PCDF (OR 0.71, p<0.001) and SSI in lumbar fusion (OR 0.84, p=0.002), but paradoxically increased sepsis risk in lumbar fusion (OR 1.32, p=0.024) and showed no effect on any ACDF outcome.
Key Limitation
Surgeon experience is measured as years in practice rather than procedure-specific case volume, making it impossible to distinguish true skill acquisition from secular trends in technique, implant design, and infection control protocols over the 20-year study period.
Original Abstract
INTRODUCTION
Outcomes research for spinal surgery has typically focused on patient, diagnosis, or procedure as a predictor of surgical results; the impact of surgeon experience remains uncertain. Although experience improves scoliosis correction and total disk arthroplasty outcomes, its effects on common procedures, including lumbar fusions, anterior cervical diskectomy and fusion (ACDF), and posterior cervical decompression and fusion (PCDF), remain understudied. This study evaluates the impact of surgeon experience on outcomes in a large, multisurgeon, multisite academic center, examining prospectively collected data.
METHODS
We analyzed 1,567 ACDF, 248 PCDF, and 1,834 lumbar fusion cases (2003 to 2023) from a multisite academic center. Data were captured prospectively but reviewed retrospectively. Cohorts were stratified by levels of fusion and procedure type. Outcomes assessed included readmissions, sepsis, surgical site infection (SSI), wound dehiscence, and long-term complications. Multivariate logistic regression was done, adjusting for age, body-mass index, sex, race, diagnoses, primary surgeon, and Elixhauser comorbidities.
RESULTS
Increased surgeon experience markedly reduces long-term complications in lumbar fusion (odds ratio [OR]: 0.83, confidence interval [CI], 0.79 to 0.88, P < 0.001) and PCDF (OR: 0.71, CI, 0.60 to 0.85, P < 0.001), along with decreasing SSI rates in lumbar fusion (OR: 0.84, CI, 0.75 to 0.94, P = 0.002). Similar effects were observed in lumbar fusion subgroups, stratified by level (single- or multilevel) and procedure (anterior lumbar interbody fusion or posterior lumbar fusion/transforaminal lumbar interbody fusion). No notable associations with experience were observed for ACDF, including long-term complications (OR: 0.93, CI, 0.76 to 1.13, P = 0.440). Notably, a notable increase in sepsis risk correlated with increased experience in lumbar fusion (OR: 1.32, CI, 1.04 to 1.68, P = 0.024).
LEVEL OF EVIDENCE
Level III.
CONCLUSION
Surgeon experience markedly reduces complications and improves lumbar fusion and PCDF outcomes, emphasizing its value in optimizing care while challenging the notion that surgeons are interchangeable.