Multidisciplinary approaches to complication reduction in complex spine surgery: a systematic review

Friedman, Gabriel N.; Benton, Joshua; Echt, Murray; Ramos, Rafael De la Garza; Shin, John H.; Coumans, Jean Valery; Gitkind, Andrew I.; Yassari, Reza; Lévêque, Jean; Sethi, Rajiv K.; Yanamadala, Vijay

doi:10.1016/j.spinee.2020.04.008

Cited by 21 publications

(14 citation statements)

References 95 publications

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“…As frailty is correlated to general surgery outcome, it might also predict the outcome in patients undergoing spine surgery, who have been reported to record a high rate of intra-and post-operative complications [17][18][19][20]. Degenerative disorders of the spine are very frequent, with 90% of adults showing some degree of degeneration of the lumbar disk or spine by age 50 [21].…”

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confidence: 99%

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

et al. 2021

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Frailty is a condition characterized by a high vulnerability to low-power stressor. Frailty increases with age and is associated with higher complications and mortality. Several indexes have been used to quantify frailty. Spine diseases, both degenerative and oncologic, frequently require surgery which is related to complications and mortality. Aim of the present systematic review was to collect the most frequently used frailty indexes in clinics to predict surgical outcomes in patients affected by spine diseases, taking into account gender differences. Three databases were employed, and 29 retrospective clinical studies were included in this systematic review. The identified spine pathologies were primary and metastatic spine tumors, adult spine deformity (ASD), degenerative spine disease (DSD), cervical deformity (CD) and other pathologies that affected lumbar spine or multiple spine levels. Eleven indexes were identified: modified Frailty Index (mFI), Adult spinal deformity frailty index (ASD-FI), mFI-5, Metastatic Spinal Tumor Frailty Index (MSTFI), Fried criteria, Cervical deformity frailty index (CD-FI), Spinal tumor frailty index (STFI), Frailty Phenotype criteria (FP), Frailty Index (FI), FRAIL scale and Modified CD-FI (mCD-FI). All these indexes correlated well with minor and major postoperative complications, mortality and length of stay in hospital. Results on gender differences and frailty are still conflicting, although few studies show that women are more likely to develop frailty and more complications in the post-operative period than men. This systematic review could help the surgeon in the adoption of frailty indexes, before the operation, and in preventing complications in frail patients.

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confidence: 99%

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

et al. 2021

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“…Three institutions have implemented a multidisciplinary pathway for complex spine surgery: The Seattle Spine Team Major Spine Pathway, the Northwestern High-Risk Spine Protocol, and the Children's Hospital of Colorado Care Pathway for Spinal Surgery and Target Zero. 21 The details of these pathways have been described, [22][23][24][25] and they have decreased surgical duration and complication rates. [26][27][28][29][30] A 2020 systematic review conducted by Friedman et al 21 found common strategies used in these pathways, including standardized preoperative studies and preoperative multidisciplinary conferencing; intraoperative protocols for communication, neuromonitoring, and blood transfusion; and postoperative floor management and discharge planning.…”

Section: Discussionmentioning

confidence: 99%

Two-Surgeon Multidisciplinary Approach to Pediatric Cervical Spinal Fusion: A Single-Institution Series and Review of the Literature

Lynch

Montgomery

Proctor

et al. 2023

Journal of Pediatric Orthopaedics

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Background: A collaborative 2-surgeon approach is becoming increasingly popular in surgery but is not widely used for pediatric cervical spine fusions. The goal of this study is to present a large single-institution experience with pediatric cervical spinal fusion using a multidisciplinary 2-surgeon team, including a neurosurgeon and an orthopedic surgeon. This team-based approach has not been previously reported in the pediatric cervical spine literature. Methods: A single-institution review of pediatric cervical spine instrumentation and fusion performed by a surgical team composed of neurosurgery and orthopedics during 2002-2020 was performed. Demographics, presenting symptoms and indications, surgical characteristics, and outcomes were recorded. Particular focus was given to describe the primary surgical responsibility of the orthopedic surgeon and the neurosurgeon. Results: A total of 112 patients (54% male) with an average age of 12.1 (range 2-26) years met the inclusion criteria. The most common indications for surgery were os odontoideum with instability (n = 21) and trauma (n = 18). Syndromes were present in 44 (39%) cases. Fifty-five (49%) patients presented with preoperative neurological deficits (26 motor, 12 sensory, and 17 combined deficits). At the time of the last clinical follow-up, 44 (80%) of these patients had stabilization or resolution of their neurological deficit. There was 1 new postoperative neural deficit (1%). The average time between surgery and successful radiologic arthrodesis was 13.2 ± 10.6 mo. A total of 15 (13%) patients experienced complications within 90 days of surgery (2 intraoperative, 6 during admission, and 7 after discharge). Conclusions: A multidisciplinary 2-surgeon approach to pediatric cervical spine instrumentation and fusion provides a safe treatment option for complex pediatric cervical cases. It is hoped that this study could provide a model for other pediatric spine groups interested in implementing a multi-specialty 2-surgeon team to perform complex pediatric cervical spine fusions. Level of Evidence: Level IV-case series.

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“…These complex reconstructive procedures are associated with high rates of perioperative adverse events. Subsequently, there has been a growing body of literature describing methods to mitigate these risks [4][5][6]. One method adopted by many healthcare systems to reduce risk and increase value is the creation of multidisciplinary teams to help manage these complex patients [7].…”

Section: Introductionmentioning

confidence: 99%

Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience

et al. 2023

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Purpose We sought to determine the incidence, origin, and timeframe of delays to adult spinal deformity surgery so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays. Methods Complex spine procedures for treatment of adult spinal deformity from 1/1/18 to 8/31/21 were identified. Procedures for infection, tumor, and urgent/emergent cases were excluded. Operations delayed due to COVID or those that were performed outside of our established perioperative care pathway were also excluded. The electronic health record was used to identify the etiology and timeline of all pre- and peri-operative delays. Results Of 235 patients scheduled for complex spine surgery, 193 met criteria for inclusion. Of these patients, 35 patients experienced a surgical delay (18.1%) with a total of 41 delays recorded. Reasons for delay include medically unoptimized (25.6%), intraoperative complication (17.9%), patient directed delay (17.9%), patient illness/injury (15.4%), scheduling complication (10.3%), insurance delay/denial (5.1%), and unknown (2.6%). Twenty-four delays experienced by 22 individuals occurred within 7 days of their scheduled surgery date. Conclusion At a single multidisciplinary center, most delays to adult spinal deformity surgery occur before a patient is admitted to the hospital, and for recommendations of additional medical workup/clearance. We suspect that the preoperative protocol might increase pre-admission delays for unoptimized patients, as the protocol is intended to ensure patients receive surgery only when they are medically ready. Further research is needed to determine the economic and system impact of delays related to a preoperative optimization protocol weighed against the reduction in adverse events these protocols can provide.

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Multidisciplinary approaches to complication reduction in complex spine surgery: a systematic review

Cited by 21 publications

References 95 publications

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

The Impact of Frailty on Spine Surgery: Systematic Review on 10 years Clinical Studies

Two-Surgeon Multidisciplinary Approach to Pediatric Cervical Spinal Fusion: A Single-Institution Series and Review of the Literature

Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience

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