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The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates

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Abstract

Study Design

Retrospective consecutive case review pre- and postintervention.

Objectives

Characterize the effects of the intervention.

Summary of Background Data

Complication rates in adult spinal deformity surgery are unacceptable. System approaches are necessary to increase patient safety. This group reported on the dual–attending surgeon approach, a live multidisciplinary preoperative screening conference, and the intraoperative protocol for the management of coagulopathy. The outcomes were demonstrated by complication rates before and after the institution of this protocol.

Methods

Forty consecutive patients in Group A were managed without the 3-pronged approach. A total of 124 consecutive patients in Group B had a dual–attending surgeon approach, were presented and cleared by a live multidisciplinary preoperative conference, and were managed according to the intraoperative protocol.

Results

Group A had an average age of 62 years (range, 39–84 years). Group B had an average age of 64 years (range, 18–84 years). Most patients in both groups had fusions from 9 to 15 levels. Complication rates in Group B were significantly lower (16% vs. 52%) (p <.001). Group B showed significantly lower return rates to the operating room during the perioperative 90-day period (0.8% vs. 12.5%) (p <.001). Group B also had lower rates of wound infection requiring debridement (1.6% vs. 7.5%), lower rates of deep vein thrombosis/ pulmonary embolism (3.2% vs. 10%), and lower rates of postoperative neurological complications (0.5% vs. 2.5%) (not significant). Group B had significantly lower rates of urinary tract infection requiring antibiotics (9.7% vs. 32.5%) (p <.001).

Conclusions

These data suggests that a team approach consisting of a dual–attending surgeon approach in the operating room, a live preoperative screening conference, and an intraoperative protocol for managing coagulopathy will significantly reduce perioperative complication rates and enhance patient safety in patients undergoing complex spinal reconstructions for adult spinal deformity.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Department of Health Services, Group Health Physicians, Virginia Mason Medical Center, University of Washington, 125 16th Avenue East, CSB-3 Neurosurgery, Seattle, WA, 98112, USA

    Rajiv K. Sethi MD

  2. Department of Anesthesia, Virginia Mason Medical Center, Seattle, WA, USA

    Ryan P. Pong MD & Stephen M. Rupp MD

  3. Department of Neurosurgery, Group Health Physicians and Virginia Mason Medical Center, Seattle, WA, USA

    Jean-Christophe Leveque MD

  4. Department of Anesthesia, Group Health Physicians, Seattle, WA, USA

    Thomas C. Dean MD & Stephen J. Olivar MD

Authors
  1. Rajiv K. Sethi MD
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  2. Ryan P. Pong MD
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  3. Jean-Christophe Leveque MD
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  4. Thomas C. Dean MD
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  5. Stephen J. Olivar MD
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  6. Stephen M. Rupp MD
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Corresponding author

Correspondence to Rajiv K. Sethi MD.

Additional information

Author disclosures: RVK (grant from Group Health Research Institute), RPP (none), JCL (none), TCD (none), SJO (none), SMR (none).

This study was funded by a Group Health Research Institute Partnership for Innovation grant and departmental sources.

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Sethi, R.K., Pong, R.P., Leveque, JC. et al. The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and Subsequent Reduction in Perioperative Complication Rates. Spine Deform 2, 95–103 (2014). https://doi.org/10.1016/j.jspd.2013.12.002

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  • DOI: https://doi.org/10.1016/j.jspd.2013.12.002

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