Defining the “Critical Elements” for the Most Common Procedures in Spine Surgery

Laratta, Joseph L.; Shillingford, Jamal N.; Cohen-Tanugi, Samuel; Lombardi, Joseph M.; Lenke, Lawrence G.; Riew, K. Daniel; Lehman, Ronald A.; Ludwig, Steven C.

doi:10.1097/brs.0000000000002416

Cited by 11 publications

(9 citation statements)

References 4 publications

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“…It has been reported that there was a statistically significant difference between neurosurgeons and orthopedic surgeons in the type of discectomy, the value of intervention after complete spinal cord injury, and the use of orthoses after fusion surgery 13) . However, other studies have demonstrated that surgeons with either training background can achieve similar results and have similar competence when treating common spinal pathologies 22,24,38) .…”

Section: Discussionmentioning

confidence: 98%

Trends in Incidence and Treatment of Herniated Lumbar Disc in Republic of Korea : A Nationwide Database Study

Jung

Lee

Hyun

et al. 2020

J Korean Neurosurg Soc

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Objective : This study aimed to determine the incidence and analyze trends of the herniated lumbar disc (HLD) based on a national database in the Republic of Korea (ROK) from January 2008 to December 2016. Methods : This study was a retrospective analysis of data obtained from the national health-claim database provided by the National Health Insurance Service for 2008-2016 using the International Classification of Diseases. The crude incidence and agestandardized incidence of HLD were calculated, and additional analysis was conducted according to age and sex. Changes in trends in treatment methods and some treatments were analyzed using the Korean Classification of Diseases procedure codes. Results : The number of patients diagnosed with HLD was 472245 in 2008 and increased to 537577 in 2012; however, it decreased to 478697 in 2016. The pattern of crude incidence and the standardized incidence were also similar. Overall, the incidence of HLD increased annually for the 30s, 40s, 50s, and 70s until 2012 and then decreased. However, the incidence of HLD for the 80s continued to increase. The crude incidence of HLD in female patients exceeded that of male patients in their middle age (30s or 40s) and was 1.5-1.6 times higher than in male patients in their 60s. The total number of open discectomy (OD) increased from 71598 in 2008 to 93942 in 2012 and then decreased to 85846 in 2016. The rate of younger patients (the 20s, 30s, and 40s) who underwent OD was decreased, and the rate of younger patients who underwent percutaneous endoscopic lumbar discectomy was increased. However, the rate of older patients (the 70s and 80s) who underwent OD was continuously increased. Conclusion : This nationwide data on HLD from 2008 to 2016 in the ROK demonstrated that the crude incidence and the standardized incidence increased until 2012 and then decreased. The annual crude incidence was different according to age and sex. These findings may be considered when deciding future health policy, especially in countries with a similar national health insurance system (or with plans to adopt). This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 98%

Trends in Incidence and Treatment of Herniated Lumbar Disc in Republic of Korea : A Nationwide Database Study

Jung

Lee

Hyun

et al. 2020

J Korean Neurosurg Soc

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“…That surgeons are entrusted to define critical portions for a given case implies that at least some portion of every case is "critical." Although there are some emerging attempts to generate consensus on what constitutes the critical portions of specific procedures [11], we cannot, at this point, definitively say what would have been critical in this case. At the very least, we would expect Dr. Kim to be present for some of the procedure, to a degree that she could personally ensure that the case was done properly (even if she was confident in Dr. Mali's work).…”

Section: The Distinction Between Overlapping and Concurrent Surgerymentioning

confidence: 94%

How Should Trainee Autonomy and Oversight Be Managed in the Setting of Overlapping Surgery?

Gallant

Langerman

2018

AMA Journal of Ethics

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This case highlights an attending surgeon's conflicts between duty to care for individual patients, train independent surgeons, and serve a patient population in an efficient manner. Although oversight of surgical residents and multiple operating room scenarios can be conducted in an ethical manner, patients might not understand the realities of surgical training and clinical logistics without explicit disclosure. Central to the ethical concerns of the case are the attending surgeon's obfuscation of resident involvement and her insufficient oversight of two concurrent procedures. Full and proper informed consent, increased transparency, better planning, and improved communication could have prevented this difficult situation.

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“…Case segment durations varied by procedure type. The definition of “critical portion” was derived from national surveys of spinal surgeons associated with AO Spine North America 20 . Laratta et al, pooled data from over 150 spinal surgeons concerning the definition of the critical portion of index spinal surgeries, identical to those included here.…”

Section: Methodsmentioning

confidence: 99%

“…Contemporaneous time-stamping of the beginning of the case closure notifies pre- and postoperative areas to prepare to receive the current patient and prepare the next patient, respectively. Defining the critical portion of the procedure followed the case definitions derived from national spinal surgery data collected by AO Spine North America 20 . The duration of the critical portion was ascertained from time-stamping, staff observation of surgical cases, and subsequent face-to-face interviews with the attending surgeons.…”

Section: Methodsmentioning

confidence: 99%

“…The definition of ''critical portion'' was derived from national surveys of spinal surgeons associated with AO Spine North America. 20 Laratta et al, pooled data from over 150 spinal surgeons concerning the definition of the critical portion of index spinal surgeries, identical to those included here. Common to all surgeries, decompression, instrumentation, and fusion portions were considered ''critical.''…”

Section: Procedural Variablesmentioning

confidence: 99%

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Policies Restricting Overlapping Surgeries Negatively Impact Access to Care, Clinical Efficiency, and Hospital Revenue

et al. 2020

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Objective:To model the financial impact of policies governing the scheduling of overlapping surgeries, and to identify optimal solutions that maximize operating efficiency that satisfy the fiduciary duty to patients.Background:Hospitals depend on procedural revenue to maintain financial health as the recent pandemic has revealed. Proposed policies governing the scheduling of overlapping surgeries may dramatically impact hospital revenue. To date, the potential financial impact has not been modeled.Methods:A linear forecasting model based on a logic matrix decision tree enabled an analysis of surgeon productivity annualized over a fiscal year. The model applies procedural and operational variables to policy constraints limiting surgical scheduling. Model outputs included case and financial metrics modeled over 1000-surgeon-year simulations. case metrics included annual case volume, case mix, operating room (OR) utilization, surgeon utilization, idle time, and staff overtime hours. Financial outputs included annual revenue, expenses, and contribution margin.Results:The model was validated against surgical data. case and financial metrics decreased as a function of increasingly restrictive scheduling scenarios, with the greatest contribution margin loses ($1,650,000 per surgeon-year) realized with the introduction of policies mandating that a second patient could not enter the OR until the critical portion of the first surgery was completed. We identify an optimal scheduling scenario that maximizes surgeon efficiency, minimizes OR idle time and revenue loses, and satisfies ethical obligations to patients.Conclusions:Hospitals may expect significant financial loses with the introduction of policies restricting OR scheduling. We identify an optimal solution that maximizes efficiency while satisfying ethical duty to patients. This forecast is immediately relevant to any hospital system that depends upon procedural revenue.

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Defining the “Critical Elements” for the Most Common Procedures in Spine Surgery

Abstract: 1.

Cited by 11 publications

References 4 publications

Trends in Incidence and Treatment of Herniated Lumbar Disc in Republic of Korea : A Nationwide Database Study

Trends in Incidence and Treatment of Herniated Lumbar Disc in Republic of Korea : A Nationwide Database Study

How Should Trainee Autonomy and Oversight Be Managed in the Setting of Overlapping Surgery?

Policies Restricting Overlapping Surgeries Negatively Impact Access to Care, Clinical Efficiency, and Hospital Revenue

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