The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates

Rajiv K Sethi; Ryan P Pong; Jean-Christophe Leveque; Thomas C Dean; Stephen J Olivar; Stephen M Rupp

doi:10.1016/j.jspd.2013.12.002

The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates

Spine Deform. 2014 Mar;2(2):95-103. doi: 10.1016/j.jspd.2013.12.002. Epub 2014 Mar 5.

Authors

Rajiv K Sethi¹, Ryan P Pong², Jean-Christophe Leveque³, Thomas C Dean⁴, Stephen J Olivar⁴, Stephen M Rupp²

Affiliations

¹ Department of Neurosurgery, Group Health Physicians and Virginia Mason Medical Center, Department of Health Services, University of Washington, Seattle, WA, USA. Electronic address: sethrk1@u.washington.edu.
² Department of Anesthesia, Virginia Mason Medical Center, Seattle, WA, USA.
³ Department of Neurosurgery, Group Health Physicians and Virginia Mason Medical Center, Seattle, WA, USA.
⁴ Department of Anesthesia, Group Health Physicians, Seattle, WA, USA.

PMID: 27927385
DOI: 10.1016/j.jspd.2013.12.002

Abstract

Study design: Retrospective consecutive case review pre- and postintervention.

Objectives: Characterize the effects of the intervention.

Summary of background data: Complication rates in adult spinal deformity surgery are unacceptable. System approaches are necessary to increase patient safety. This group reported on the dual-attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol for the management of coagulopathy. The outcomes were demonstrated by complication rates before and after the institution of this protocol.

Methods: Forty consecutive patients in Group A were managed without the 3-pronged approach. A total of 124 consecutive patients in Group B had a dual-attending surgeon approach, were presented and cleared by a live multidisciplinary preoperative conference, and were managed according to the intraoperative protocol.

Results: Group A had an average age of 62 years (range, 39-84 years). Group B had an average age of 64 years (range, 18-84 years). Most patients in both groups had fusions from 9 to 15 levels. Complication rates in Group B were significantly lower (16% vs. 52%) (p < .001). Group B showed significantly lower return rates to the operating room during the perioperative 90-day period (0.8% vs. 12.5%) (p < .001). Group B also had lower rates of wound infection requiring debridement (1.6% vs. 7.5%), lower rates of deep vein thrombosis/pulmonary embolism (3.2% vs. 10%), and lower rates of postoperative neurological complications (0.5% vs. 2.5%) (not significant). Group B had significantly lower rates of urinary tract infection requiring antibiotics (9.7% vs. 32.5%) (p < .001).

Conclusions: These data suggests that a team approach consisting of a dual-attending surgeon approach in the operating room, a live preoperative screening conference, and an intraoperative protocol for managing coagulopathy will significantly reduce perioperative complication rates and enhance patient safety in patients undergoing complex spinal reconstructions for adult spinal deformity.

Keywords: Adult; Approaches; Complications; Deformity; System.