Spine Journal - 2026-03-06 - Journal Article
A dedicated spine team is more efficient and improves perioperative outcomes in idiopathic scoliosis surgery: a propensity score-matched study.
Lee SY, Iwamae M, Chiu CK, Leong AWY, Ting HC, Takahashi S, Terai H, Hasan MS, Chan CYW, Kwan MK
Topics
Key Takeaway
A dedicated spine team (DST) reduced operative time by 67.7 minutes (138.5 vs. 206.2 min, p<0.001) and postoperative PCA morphine usage compared to a nondedicated team in posterior spinal fusion for idiopathic scoliosis.
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Summary
This study compared operating theatre efficiency and perioperative outcomes between a dedicated spine team (DST) using dual attending surgeons with consistent ancillary staff versus a nondedicated team (NDST) using one attending plus a fellow in posterior spinal fusion for idiopathic scoliosis. After propensity score matching, DST demonstrated significantly shorter preoperative (38.1 vs. 75.1 min), operative (138.5 vs. 206.2 min), and postoperative (13.8 vs. 35.0 min) times, with reduced total blood loss and lower PCA morphine consumption. Multivariate regression confirmed DST as an independent predictor of shorter operative time (β=-0.53) and lower morphine usage (β=-0.52), while total blood loss was independently associated with operative time (β=0.63).
Key Limitation
The NDST group was substantially smaller at baseline (55 vs. 180 cases), suggesting selection bias in case allocation that propensity matching cannot fully eliminate, and the single-institution design limits generalizability to centers without three senior spine consultants available for dual-attending coverage.
Original Abstract
BACKGROUND CONTEXT
Operating theatre (OT) inefficiency often leads to unnecessary healthcare expenditure. A dedicated spine team (DST) approach may enhance OT efficiency in scoliosis surgeries. However, its adoption remains debatable, as some believe it may require significant investment in training and expertise, pose potential administrative challenges, and question whether the perceived impact on perioperative outcomes justifies these efforts.
PURPOSE
This study aimed to evaluate the OT efficiency and perioperative outcomes of the DST approach compared with the nondedicated spine team (NDST) approach.
STUDY DESIGN
Retrospective study.
PATIENT SAMPLE
This study initially identified 235 patients with idiopathic scoliosis (IS) who underwent posterior spinal fusion (PSF) using either the DST or NDST approach between 2022 and 2024. Patients were divided into two groups: DST (180 cases) and NDST (55 cases). Following propensity score matching (PSM), 74 patients were included in the final analysis, with 37 cases matched to each group.
OUTCOME MEASURES
Primary outcomes included OT efficiency (represented by preoperative time, operative time, postoperative time, and total OT time), total blood loss and salvaged blood volume, perioperative complications, postoperative major Cobb angle, hemoglobin (Hb) level, blood transfusion requirement, postoperative patient-controlled analgesia (PCA) morphine usage, and length of hospital stay. Operative time was subdivided into four stages (Stage 1: exposure, Stage 2: screw insertion, Stage 3: correction and balancing, and Stage 4: corticotomies, bone grafting, and closure).
METHODS
The DST comprised three senior spine consultants who operated using a dual attending surgeon strategy, supported by a dedicated anesthetic consultant, and a consistent OT team, including orthopedic scrub nurses, anesthetic nurses, radiographers, and neuromonitoring technicians. The NDST comprised one attending surgeon (from the DST), one spine surgery fellow as the second surgeon, as well as anesthetic and OT staff assigned according to the OT roster. The intraoperative team size was identical between the two groups. PSM was performed using nearest-neighbor matching with a match tolerance of 0.05. Multiple linear regression analysis was performed to identify factors influencing the outcomes.
RESULTS
Following PSM, 37 cases were included in each group. There were significant differences between the DST and NDST in preoperative time (38.1±4.5 minutes vs. 75.1±19.1 minutes), operative time (138.5±35.1 minutes vs. 206.2±44.4 minutes), and postoperative time (13.8±4.4 minutes vs. 35.0±25.8 minutes) (p<.001). The DST had significantly shorter duration in Stage 1 (exposure), Stage 2 (screw insertion), and Stage 4 (corticotomies, bone grafting, and closure) as compared to the NDST (p<.001). The DST had significantly lesser total blood loss (p=.029) and postoperative PCA morphine usage (p<.001) than the NDST. Multiple linear regression analysis revealed that the DST approach was significantly associated with shorter operative time (β=-0.53, p<.001) and lower postoperative PCA morphine usage (β=-0.52, p=.016). Total blood loss was independently associated with operative time (β=0.63, p<.001).
CONCLUSION
The DST approach in PSF was significantly associated with shorter operative time and, as a secondary outcome, reduced postoperative PCA morphine usage. Total blood loss was independently associated with operative time.