The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

Zeeni, Carine; Carabini, Louanne M.; Gould, Robert W.; Bebawy, John F.; Hemmer, Laura B.; Moreland, Natalie C.; Koski, Tyler R.; Koht, Antoun; Schäfer, Michael F.; Ondra, Stephen L.; Gupta, Dhanesh K.

doi:10.1016/j.wneu.2014.06.020

Cited by 21 publications

(15 citation statements)

References 39 publications

(45 reference statements)

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“…14-16 For example, our finding that the number of levels fused is associated with ICU admission is consistent with adherence to the Northwestern High Risk Spine Protocol that prompts ICU admission for long-segment thoracolumbar fusions. 14-16…”

Section: Discussionsupporting

confidence: 72%

Surgical Site Infection in the Intensive Care Setting After Posterior Spinal Fusion: A Case Series Highlighting the Microbial Profile, Risk Factors, and the Importance of Comorbid Disease Burden

Cloney

Hopkins

Shlobin

et al. 2022

Operative Neurosurgery

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BACKGROUND:Most posterior spinal fusion (PSF) patients do not require admission to an intensive care unit (ICU), and those who do may represent an underinvestigated, high-risk subpopulation.OBJECTIVE:To identify the microbial profile of and risk factors for surgical site infection (SSI) in PSF patients admitted to the ICU postoperatively.METHODS:We examined 3965 consecutive PSF patients treated at our institution between 2000 and 2015 and collected demographic, clinical, and procedural data. Comorbid disease burden was quantified using the Charlson Comorbidity Index (CCI). We performed multivariable logistic regression to identify risk factors for SSI, readmission, and reoperation.RESULTS:Anemia, more levels fused, cervical surgery, and cerebrospinal fluid leak were positively associated with ICU admission, and minimally invasive surgery was negatively associated. The median time to infection was equivalent for ICU patients and non-ICU patients, and microbial culture results were similar between groups. Higher CCI and undergoing a staged procedure were associated with readmission, reoperation, and SSI. When stratified by CCI into quintiles, SSI rates show a strong linear correlation with CCI (P = .0171, R = 0.941), with a 3-fold higher odds of SSI in the highest risk group than the lowest (odds ratio = 3.15 [1.19, 8.07], P = .032).CONCLUSION:Procedural characteristics drive the decision to admit to the ICU postoperatively. Patients admitted to the ICU have higher rates of SSI but no difference in the timing of or microorganisms that lead to those infections. Comorbid disease burden drives SSI in this population, with a 3-fold greater odds of SSI for high-risk patients than low-risk patients.

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Section: Discussionsupporting

confidence: 72%

Surgical Site Infection in the Intensive Care Setting After Posterior Spinal Fusion: A Case Series Highlighting the Microbial Profile, Risk Factors, and the Importance of Comorbid Disease Burden

Cloney

Hopkins

Shlobin

et al. 2022

Operative Neurosurgery

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“…Thus, at the time of patient’s preparation to the surgery, paying attention to factors associated with the need for perioperative blood transfusion, like the ones emerged from our study, i.e., ASA class, expected operative time, and baseline HB level, may provide guidance to determine which patients will benefit from preoperative optimization of the RBC mass, and in the planning for perioperative invasive monitoring, intravenous access, blood product availability, and eventually administration of anti-fibrinolytics [ 14 , 40 ]. Efforts to minimize perioperative administration of blood products might decrease the costs associated with blood transfusion that range between 700–1200 US dollars for administration of one RBC unit, plus additional costs up to 1000 US dollars for treatment of associated side effects [ 13 , 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

“…Efforts to minimize perioperative administration of blood products might decrease the costs associated with blood transfusion that range between 700–1200 US dollars for administration of one RBC unit, plus additional costs up to 1000 US dollars for treatment of associated side effects [ 13 , 41 , 42 ]. Indeed, when high-risk patients were identified and an optimization protocol was initiated, a significant reduction in perioperative transfusions was reported, with a cost of approximately 850 US dollars, which represented a clearly favorable approach as it was still cheaper than one unit of RBC and its side effects [ 36 , 40 ]. Another interventional cohort study demonstrated that within 1 year from the introduction of a program of patient blood management, transfusions of all allogeneic blood products per 1000 patients was reduced by 27% with a cost reduction of over 2 million US dollars on a hospital level [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Ristagno

Beluffi

Tanzi

et al. 2018

JCM

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(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

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“…The strength of the Northwestern High-Risk Spine Protocol is grounded in their meticulous preoperative medical workup and optimization, strong interdisciplinary communication, protocolized operative and postoperative care, and finally the dedication of one multidisciplinary team for the entirety of the patient’s care. 8 Zeeni et al 140 reported successful implementation of their intraoperative protocol with significant improvement in the duration of surgical procedures and reduced transfusion requirements.…”

Section: Quality Improvement Initiativementioning

confidence: 99%

Quality and Safety Improvement in Spine Surgery

Jiang

Wilson

Badhiwala

et al. 2020

Global Spine Journal

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Study Design: Review article. Objectives: A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. Methods: A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. Results: Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. Conclusion: Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.

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The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

Cited by 21 publications

References 39 publications

Surgical Site Infection in the Intensive Care Setting After Posterior Spinal Fusion: A Case Series Highlighting the Microbial Profile, Risk Factors, and the Importance of Comorbid Disease Burden

Surgical Site Infection in the Intensive Care Setting After Posterior Spinal Fusion: A Case Series Highlighting the Microbial Profile, Risk Factors, and the Importance of Comorbid Disease Burden

Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Quality and Safety Improvement in Spine Surgery

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