Does a dedicated "Scoliosis Team" and surgical standardization improve outcomes in adolescent idiopathic scoliosis surgery and is it reproducible?
Adolescent idiopathic scoliosis
Posterior spinal fusion
Scoliosis
Standardization
Journal
Spine deformity
ISSN: 2212-1358
Titre abrégé: Spine Deform
Pays: England
ID NLM: 101603979
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
13
04
2023
accepted:
24
06
2023
pubmed:
29
7
2023
medline:
29
7
2023
entrez:
28
7
2023
Statut:
ppublish
Résumé
The objective of this study was to determine if standardization improves adolescent idiopathic scoliosis (AIS) surgery outcomes and whether it is transferrable between institutions. A retrospective review was conducted of AIS patients operated between 2009 and 2021 at two institutions (IA and IB). Each institution consisted of a non-standardized (NST) and standardized group (ST). In 2015, surgeons changed institutions (IA- > IB). Reproducibility was determined between institutions. Median and interquartile ranges (IQR), Kruskal-Wallis, and χ 500 consecutive AIS patients were included. Age (p = 0.06), body mass index (p = 0.74), preoperative Cobb angle (p = 0.53), and levels fused (p = 0.94) were similar between institutions. IA-ST and IB-ST had lower blood loss (p < 0.001) and shorter surgical time (p < 0.001). IB-ST had significantly shorter hospital stay (p < 0.001) and transfusion rate (p = 0.007) than IB-NST. Standardized protocols in IB-ST reduced costs by 18.7%, significantly lowering hospital costs from $74,794.05 in IB-NST to $60,778.60 for IB-ST (p < 0.001). Annual analysis of surgical time revealed while implementation of standardized protocols decreased operative time within IA, when surgeons transitioned to IB, and upon standardization, IB operative time values decreased once again, and continued to decrease annually. Additions to standardized protocol in IB temporarily affected the operative time, before stabilizing. Surgeon-led standardized AIS approach and streamlined surgical steps improve outcomes and efficiency, is transferrable between institutions, and adjusts to additional protocol changes.
Identifiants
pubmed: 37507585
doi: 10.1007/s43390-023-00728-4
pii: 10.1007/s43390-023-00728-4
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1409-1418Informations de copyright
© 2023. The Author(s), under exclusive licence to Scoliosis Research Society.
Références
Reames DL, Smith JS, Fu K-MG et al (2011) Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine 36:1484–1491
doi: 10.1097/BRS.0b013e3181f3a326
pubmed: 21037528
Patil CG, Santarelli J, Lad SP et al (2008) Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. The Spine Journal 8:904–910
doi: 10.1016/j.spinee.2008.02.002
pubmed: 18358787
Carreon LY, Puno RM, Lenke LG et al (2007) Non-neurologic complications following surgery for adolescent idiopathic scoliosis. JBJS Am 89:2427–2432
doi: 10.2106/00004623-200711000-00013
pubmed: 17974885
Diab M, Smith AR, Kuklo TR et al (2007) Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine 32:2759–2763
doi: 10.1097/BRS.0b013e31815a5970
pubmed: 18007257
Bauer J, Shah S, Sponseller P et al (2020) Comparing short-term AIS post-operative complications between ACS-NSQIP and a surgeon study group. Spine Deform 8(6):1247–1252
doi: 10.1007/s43390-020-00170-w
pubmed: 32720267
Ramos R, Goodwin C, Abu-Bonsrah N et al (2016) Patient and operative factors associated with complications following adolescent idiopathic scoliosis surgery: an analysis of 36,335 patients from the Nationwide Inpatient Sample. J Neurosurg 18(6):730–736
Dahlke J, Mendez-Figueroa H, Maggio L et al (2020) The case for standardizing cesarean delivery technique: seeing the forest for the trees. Obstet Gynecol 136(5):972–980
doi: 10.1097/AOG.0000000000004120
pubmed: 33030865
pmcid: 7575029
Eto K, Urashima M, Kosuge M et al (2018) Standardization of surgical procedures to reduce risk of anastomotic leakage, reoperation, and surgical site infection in colorectal cancer surgery: a retrospective cohort study of 1189 patients. Int J Colorectal Dis 33:755–762
doi: 10.1007/s00384-018-3037-3
pubmed: 29602975
Halpin RJ, Sugrue PA, Gould RW et al (2010) Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol. Spine 35:2232–2238
doi: 10.1097/BRS.0b013e3181e8abb0
pubmed: 21102298
Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232
pubmed: 21936146
Ho D, Huo M (2007) Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations? J Am Coll Surg 205(1):97–100
doi: 10.1016/j.jamcollsurg.2007.03.009
pubmed: 17617338
Delitto D, Black B, Cunningham H et al (2016) Standardization of surgical care in a high-volume center improves survival in resected pancreatic head cancer. Am J Surg 212(2):195–201
doi: 10.1016/j.amjsurg.2016.03.001
pubmed: 27260793
pmcid: 4969126
Jones L, Exworthy M (2015) Framing in policy processes: a case study from hospital planning in the National Health Service in England. Soc Sci Med 124:196–204
doi: 10.1016/j.socscimed.2014.11.046
pubmed: 25461877
O’Malley S, Sanders J, Nelson S, Rubery P, O’Malley N, Aquina C (2021) Significant variation in blood transfusion practice persists following adolescent idiopathic scoliosis surgery. Spine 46(22):1588–1597
doi: 10.1097/BRS.0000000000004077
pubmed: 33882540
Minvielle E (2018) Toward customized care. Int J Health Policy Manag 7(3):272–274
doi: 10.15171/ijhpm.2017.84
pubmed: 29524957
Mannion R, Davies H. Cultures in Healthcare. In: Ferlie E, Montgomery K, Reff Pedersen A, eds. Oxford Handbook of Health Care Management. Oxford: Oxford University Press; 2016.
Rampersaud YR, Moro ER, Neary MA et al (2006) Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine 31:1503–1510
doi: 10.1097/01.brs.0000220652.39970.c2
pubmed: 16741462
Hamilton DK, Smith JS, Sansur CA et al (2011) Rates of new neurological deficit associated with spine surgery based on 108,419 procedures. Spine Deform 3(15):1218–1228
doi: 10.1097/BRS.0b013e3181ec5fd9