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Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery

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Abstract

Purpose

In 2018, Best Practice Guidelines (BPGs) were published for preventing wrong-level surgery in pediatric spinal deformity, but successful implementation has not been established. The purpose of this study was to evaluate BPG compliance 5 years after publication. We hypothesized higher compliance among BPG authors and among surgeons with more experience, higher caseload, and awareness of the BPGs.

Methods

We queried North American and European surgeons, authors and nonauthors, and members of pediatric spinal study groups on adherence to BPGs using an anonymous survey consisting of 18 Likert scale questions. Respondents provided years in practice, yearly caseload, and guideline awareness. Mean compliance scores (MCS) were developed by correlating Likert responses with MCS scores (“None of the time” = no compliance = MCS 0, “Sometimes” = weak to moderate = MCS 1, “Most of the time” = high = MCS 2, and “All the time” = perfect = MCS 3).

Results

Of the 134 respondents, 81.5% reported high or perfect compliance. Average MCS for all guidelines was 2.4 ± 0.4. North American and European surgeons showed no compliance differences (2.4 vs. 2.3, p = 0.07). Authors and nonauthors showed significantly different compliance scores (2.8 vs 2.4, p < 0.001), as did surgeons with and without knowledge of the BPGs (2.5 vs 2.2, p < 0.001). BPG awareness and compliance showed a moderate positive correlation (r = 0.48, p < 0.001), with non-significant associations between compliance and both years in practice (r = 0.41, p = 0.64) and yearly caseload (r = 0.02, p = 0.87).

Conclusion

Surgeons reported high or perfect compliance 81.5% of the time with BPGs for preventing wrong-level surgery. Authorship and BPG awareness showed increased compliance. Location, study group membership, years in practice, and yearly caseload did not affect compliance.

Level of evidence

Level V—expert opinion.

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Data availability

Data available if requested to primary author.

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Acknowledgements

Special thanks to Regina Wood, MPH from PSSG and Michelle Marks, PT MA from the Harms study group for their help with the distribution of the survey. Our gratitude also goes to Drs. Carol Hasler, René Castelein, Sébastien Pesenta, Ilkka Helenius, Dror Ovadia, David Farrington, Muharrem Yazici, Moyo Kruyt, Jorge Mineiro, and Oliana Madeira for helping distribute our survey among the EPOS Spine Study Group.

Funding

This study was not conducted with financial support.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA

    Alondra Concepción-González, J. Manuel Sarmiento, Christina C. Rymond, Hannah Lin, Kevin Lu, Afrain Z. Boby, Benjamin D. Roye & Michael G. Vitale

  2. Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA

    J. Manuel Sarmiento, Chinenye Ezeh, Benjamin D. Roye & Michael G. Vitale

  3. David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA

    Rishi Sinha

  4. Department of Biostatistics, Columbia University, New York, NY, USA

    Prakash Gorroochurn

  5. Division of Pediatric Orthopaedic Surgery, Mayo Clinic, Rochester, MN, 55902, USA

    A. Noelle Larson

  6. Pediatric Orthopaedic Department, Robert Debré Hospital, APHP, Cité University, Paris, Paris, France

    Brice Ilharreborde

  7. Department of Orthopaedic Surgery, Morgan Stanley Children’s Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Alondra Concepción-González, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA

    Alondra Concepción-González

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  1. Alondra Concepción-González
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  6. Hannah Lin
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Consortia

European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group

  • Regina Wood
  • , Michelle Marks
  • , Carol Hasler
  • , René Castelein
  • , Sébastien Pesenta
  • , Ilkka Helenius
  • , Dror Ovadia
  • , David Farrington
  • , Muharrem Yazici
  • , Moyo Kruyt
  • , Jorge Mineiro
  •  & Oliana Madeira

Contributions

Alondra Concepción-González BA, J. Manuel Sarmiento MD, Christina C. Rymond BA, Chinenye Ezeh MPH, Rishi Sinha MD, Hannah Lin, Kevin Lu MS, Afrain Z. Boby MS, Prakash Gorroochurn PhD, A. Noelle Larson MD, Benjamin D. Roye MD MPH, Brice Iharreborde MD, Michael G. Vitale MD MPH, European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work, Drafted the work or revised it critically for important intellectual content, Approved the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Alondra Concepción-González.

Ethics declarations

Ethics approval

This study was approved by the Columbia University Institutional Review Board (Protocol AAAU3145) and was performed in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

This study qualifies for a waiver of consent, because it is a survey of surgeons and does not involve patient participation. There is no potential to adversely affect the rights or welfare of subjects, since this is a survey to gather surgeon opinion, with no patient data being collected or intervention being tested.

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The members of the instutional author group “European Pediatric Orthopaedic Society Spine Study Group, Pediatric Spine Study Group, Harms Study Group” was processed under acknowledgements section.

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Concepción-González, A., Sarmiento, J.M., Rymond, C.C. et al. Evaluating compliance with the best practice guidelines for wrong-level surgery prevention in high-risk pediatric spine surgery. Spine Deform (2024). https://doi.org/10.1007/s43390-024-00836-9

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