Objective: In recent years, the number of patients requiring spinal metastasis surgery has been increasing via the increase in the number of patients with cancer due to the aging of the population and the rapid progress in cancer treatment. While, in spine metastasis surgery, appropriate spinal decompression and spinal stabilization with instrumentation are essential and surgeons require adequate surgeon proficiency, the impact of surgeon experience on postoperative outcomes is still unclear. The aim of this study is to investigate the relationship between surgeon experience and postoperative outcomes in spine metastasis surgery.
Methods: A total of 271 spinal metastasis surgery patients registered with the Cancer Board between 2015 and 2021 were classified into two groups: an expert group (n = 200), in which the surgeon was a board-certified spine surgeon of the Japanese Society for Spine Surgery and Related Research, and a non-expert group (n = 71), in which the surgeon had not yet obtained a board-certified spine surgeon’s degree. After propensity score matching (n = 70 for each group), postoperative clinical outcomes, complications, accuracy of pedicle screw insertion, and life expectancy were evaluated. Clinical outcomes were compared between the two groups for performance status (PS), Barthel Index, and EuroQOL-5 Dimension (EQ-5D) up to 6 months postoperatively. Complications were defined as Grade 2 or higher using the Clavien-Dindo classification. Accuracy of pedicle screw insertion was evaluated using Gertzbein-Robbins classification. Kaplan-Meier curves were generated and compared for life expectancy.
Results: In the comparison of postoperative clinical outcomes, there were no significant differences in PS, Barthel Index, or EQ-5D between the two groups (3 months postoperatively, senior group/ junior group, PS (median); 2/2, p = 0.77, Barthel Index (mean); 80.7/83.8, p = .57, EQ-5D (mean); 0.628/0 .668, p = 0.65). The overall complication rate was 14% (20 patients), and those in each group were similar between the two groups (expert group/non-expert group, 16/14%, p = 0.63). There were no significant differences in life expectancy (p = 0.49) and accuracy of pedicle screw insertion (expert group/non-expert group, 95/95%, p = 0.65) between the two groups.
Discussion: This study demonstrates that the clinical outcomes, complications, and life expectancy of spinal metastasis surgery are not affected by the surgeon's experience. This indicates that spinal metastasis surgery is consistently effective regardless of the surgeon's experience. In conclusion, spine surgeons should consider spinal metastasis surgery when faced with a patient who requires such a procedure, regardless of the surgeon's experience.