Safety in Complex Spine Surgery

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Surgeries that correct spinal deformities can carry a high risk of morbidity during surgery. The most dangerous is reconstructive adult spinal deformity surgery, with morbidity rates ranging from 20% to 90%. However, patients report significant improvements in their quality of life following the procedure, even those who suffer complications. The delivery of surgical care to patients with complex spinal deformities requires many steps, across multiple health care systems. This, along with the variability of institutions and surgeons, and the potential for error in the overall work processes surrounding complex surgical spine care is staggering. As a result, providers proposed creating standardized work processes and manufacturing methodologies to improve efficiency and safety. These principles can be applied to patient care from the initial preop assessment to the postop follow-up.

Columbia Orthopedics Chief of Pediatric Spine and Scoliosis Surgery Michael G. Vitale, MD and authors from other institutions set out to create a state-of-the-art review, titled "State of the Art Reviews: Safety in Complex Spine Surgery" to provide readers with an understanding of the existing knowledge regarding safety in complex spine surgery, and introduce standard work processes as a method to enhance safety in complex spine surgery.

“Spinal deformities are being diagnosed with more regularity,” stated Dr. Vitale, “so it has become imperative for us to improve safety practices during these surgeries.”

Early evidence suggests that short-term outcomes can be improved by implementing packages of systems reform aimed at reducing variability in our work processes; however, contradicting evidence exists on the utility of several specific components of these systems-reform packages.

“Due to the complex nature of these cases, in addition to the complicated healthcare systems in which they occur, the development of a standard work flow is essential,” said Dr. Vitale. “Remaining committed to safety requires a continuous precedent of inquiry and investigation.”

While the early results are promising, there is not enough evidence tied to whether or not the improved outcomes resulted from standardized work protocols or from increased surgeon experience with a renewed focus on safety. It is also unclear if the experiences of a few institutions are applicable to others. More data is needed, from a variety of institutions, to validate if standard work protocols improve patient safety and outcomes in complex spine cases. 

Read more about the review in Spine Deformity.