TWO CONSULTANT SPINAL OPERATING: OPERATOR PERCEIVED BENEFITS.

Editor,

There have been few documented studies looking at joint consultant spinal operating.[1-3] Within the Royal Victoria Hospital, it is routine for spinal consultants to operate in pairs for complex cases. The benefits of joint operating to either the patient or the surgeon are however unclear.

As a result, a study was undertaken to determine if participating surgeons felt there was any perceived benefit for either the surgeon or the patient. From the 27th September 2011 to the 26th September 2013, there were 43 documented joint consultant spinal operating cases at the main Royal Victoria Hospital site.

19 (44.19%) spinal stabilisation or fusion at any level.

18 (41.86%) Scoliosis operations.

6 (13.95%) Other (including tumour biopsy, wound wash out and kyphoplasty)

To assess if there was any operator perceived benefit, a 5 Question Survey was compiled. This was then sent to 300 Consultant Spinal Surgeons within the UK. A reply was received from 111 Consultants. Results were collated and both qualitative and quantitative data assessed (Fig.1).

Figure 1

The survey demonstrated that 94.50% had been involved in joint consultant operating and 93.64% felt that joint operating was beneficial. It was found that more complex and rarely performed cases were favoured for joint consultant surgery. A few responses, however, stated that consultants should be able to perform these operations by themselves. Although this is true the potential benefits for the patient would encourage joint operating.[1]

The perceived benefits for the patient included shorter surgery time, less blood loss and fewer post-operative complications. The perceived benefits for the surgeon included less stress with shared responsibility and experience. (Fig. 2)

Figure 2

Conclusion

We believe joint consultant operating is an essential practice and should be used to share knowledge, increase skills and impact positively on patient outcomes. We also believe that this will be true for other surgical specialities. The survey analysis indicated that joint consultant operating is perceived by surgeons to be beneficial for both patient and surgeon. Conversely, there was some concern over registrar training, as opportunities to scrub would not be so readily available. Our feeling however is that actual operating time for the registrar is far outweighed by the invaluable knowledge gained by assisting two consultants.

Research into this area has shown a reduction in operative blood loss, decreased stay in hospital and a reduction in complication rate.[1, 3] A local study, quantifying outcomes from single and joint consultant operating needs to be undertaken to determine if there is any actual benefit to either the surgeon or the patient.