Vol.:(0123456789) 1 3 Spine Deformity https://doi.org/10.1007/s43390-020-00049-w CASE SERIES A dual‑team approach benefts standard‑volume surgeons, but has minimal impact on outcomes for a high‑volume surgeon in AIS patients Vishal Sarwahi 1  · Jesse Galina 1  · Stephen Wendolowski 1  · Jon‑Paul Dimauro 1  · Marina Moguilevich 2  · Chhavi Katyal 2  · Beverly Thornhill 2  · Yungtai Lo 3  · Terry D. Amaral 1 Received: 19 July 2019 / Accepted: 30 November 2019 © Scoliosis Research Society 2020 Abstract Study design Retrospective chart review of prospectively collected data. Objective This study seeks to evaluate the efect of number of surgeons, surgeon experience, and surgeon volume on AIS surgery. Summary of background data Recent literature suggests that utilizing two surgeons for spine deformity correction surgery can improve perioperative outcomes. However, the surgeon’s experience and surgical volume are likely as important. Methods AIS patients undergoing PSF from 2009 to 2019 were included. Patient demographics, X-ray and perioperative outcomes were collected and collated based on primary surgeon. Analysis was performed for single versus dual surgeons, surgeon experience (≤ 10 years in practice), and surgical volume (less/greater than 50 cases/year). Median (IQR) values, Wilcoxon Rank Sums test, Kruskal–Wallis test, and Fisher’s exact test were utilized. Results 519 AIS cases, performed by 4 surgeons were included. Two surgeons were highly experienced, 1 of whom was also high volume. Five cohorts were studied: a single senior high volume (S1) (n = 302), dual-junior surgeons (DJ) (n = 73), dual senior–junior (SJ) (n = 36), dual-senior (DS) (n = 21) and a single senior, standard-volume surgeon alone (S2) (n = 87). Radiographic parameters were similar between the groups (p > 0.05). Preoperative Cobb was signifcantly higher for DS compared to S1 (p = 0.034) Pre- and post-op kyphosis were similar (p > 0.05). Cobb correction was similar (p > 0.05). Levels fused, fxation points, anesthesia and surgical times were similar (p > 0.05). When the standard-volume surgeon operated with a second surgeon, radiographic parameters were similar (p > 0.05), but anesthesia time, surgical time, and hospital length of stay were signifcantly shorter (p < 0.05). Additionally, DJ had signifcantly shorter anesthesia and operative times (p < 0.001) and length of stay (p < 0.001) compared to S2. Conclusion Standard-volume surgeons have better outcomes with a dual surgeon approach. Junior surgeons beneft operating with an experienced surgeon. A high-volume surgeon, however, does not beneft from a dual surgeon approach. Level of evidence Level II. Keywords Idiopathic scoliosis · Posterior spinal fusion · Surgeon volume · Complication rate · Pedicle screws Introduction Adolescent idiopathic scoliosis (AIS) surgery is a complex surgery associated with signifcant risks [1–5]. Factors that increase risks include long anesthesia and surgery times, high estimated blood loss (EBL), and blood transfusions [2, 6]. Recent literature suggests a dual attending surgeon approach for AIS can improve perioperative outcomes [7–9]. Kwan et al. reviewed 60 Lenke 1 and 2 AIS patients under- going posterior selective thoracic fusion. Operative time for dual surgeons was 93.3 min shorter, and EBL was 361 mL * Vishal Sarwahi vsarwahi@northwell.edu 1 Department of Pediatric Orthopaedics, Center for Advanced Pediatric Orthopaedics, Cohen Children’s Medical Center, Northwell Health System, 7 Vermont Drive, New Hyde Park, NY 11042, USA 2 Department of Orthopaedic Surgery, Montefore Medical Center, Bronx, NY, USA 3 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA