Complication avoidance with pre-operative screening: insights from the Seattle spine team

Abstract

Complication rates for complex adult lumbar scoliosis surgery are unacceptably high. Standardized preoperative evaluation protocols have been shown to significantly reduce the likelihood of a spectrum of negative outcomes associated with complex adult lumbar scoliosis surgery. To increase patient safety and reduce complication risk, an entire medical and surgical team should work together to care for adult lumbar scoliosis patients. This article describes preoperative patient evaluation strategies with a particular focus on adult lumbar scoliosis surgery involving six or more levels of spinal fusion. Domains considered include recent preoperative evaluation literature, predictive risk modeling, the appropriate management of medical conditions, and the composition and activities of a multidisciplinary conference review team. An evidence-based comprehensive systematic preoperative surgical evaluation process is described.

Patient‐Reported Outcome Measures: Utility for Predicting Spinal Surgery in an Integrated Spine Practice

“…This is a significantly lower rate of surgical intervention as compared with other studies [19][20][21]. This may reflect the highly integrated nature of our practice, which includes a multidisciplinary conference before spinal fusion, which we has been shown to reduce our overall surgical rate [15,22,23]. As we are better able to achieve patient engagement and to capture long-term follow-up data at regular intervals, we will be able to better understand how our interventions affect patient function.…”

Classification of Adult Spinal Deformity: Review of Current Concepts and Future Directions

“…Incorporating patient and surgical characteristics like older age, higher ASA grade, clinical comorbid conditions, obesity, larger preoperative Cobb angle, and requirement of increasing three-column osteotomies for ideal radiographic alignment that predict poorer outcomes after surgery into future classification systems, may allow the surgeons to target these specific variables to improve patient outcomes after ASD surgery. The Seattle spine team approach for adult spine deformity surgery has described three-pronged approach aimed to reduce perioperative complication rates and enhance patient safety in patients undergoing complex spinal reconstructions for ASD 50,51) . This group reported on the dual-attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol for the management of coagulopathy to mitigate perioperative complications in ASD surgery.…”

“…Complication rates were significantly lower (16% vs. 52%; p<0.001) after the introduction of Seattle spine team approach in surgical management of ASD patients. Development of risk mitigating approaches, like Seattle spine team approach and sliding scale for selection for appropriate surgical procedure, after considering particular patients' overall ability to tolerate the level of morbidity of a surgical intervention will be effective in reducing the perioperative complication rates in ASD surgery 50,51) .…”

A systematic multidisciplinary initiative for reducing the risk of complications in adult scoliosis surgery

“…Surgery is delayed for patients not currently suitable for it (e.g., those who require smoking cessation, weight loss, or further medical consultation) and potentially denied for those who are unable to complete medical optimization. Additional detail on the specifics of the protocol were published by Sethi et al 20 in 2014 and Buchlak et al 5 in 2016.…”