Standardizing Care for High-Risk Patients in Spine Surgery

Halpin, Ryan J.; Sugrue, Patrick A.; Gould, Robert W.; Kallas, Peter; Schäfer, Michael F.; Ondra, Stephen L.; Koski, Tyler R.

doi:10.1097/brs.0b013e3181e8abb0

Cited by 82 publications

(29 citation statements)

References 56 publications

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“…Not surprisingly, these patients require the coordinated efforts of a variety of health care providers to mitigate perioperative morbidity and mortality (18). In 2005, 1 patient died during a posterior thoracolumbar fusion revision with several major vertebral osteotomies, which was complicated by unanticipated massive surgical hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

et al. 2014

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Section: Introductionmentioning

confidence: 99%

The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

et al. 2014

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“…Furthermore, a need for evidencebased protocols for responding to neuromonitoring alerts has been recognized, 17 and to this end some groups have proposed management protocols for high-risk spine patients that include responses to neuromonitoring changes. 23,40 In light of the recent evidence demonstrating the potential benefit of checklists in emergent situations, and based on a recognized need to quickly and effectively respond to intraoperative monitoring changes in a cohesive fashion, we sought to develop a checklist for responding to intraoperative monitoring alerts.…”

Section: 2941mentioning

confidence: 99%

“…This management protocol, however, is meant to encompass the full scope of care of high-risk spine patients from their preoperative evaluation through their postoperative course. 23 This broad and comprehensive protocol may not be ideally suited for the rapid response needed in the event of intraoperative neuromonitoring signal change.…”

mentioning

confidence: 99%

“…Their algorithm, however, is not presented in simple checklist form, which may limit its utility in the time-critical scenario encountered in the event of intraoperative monitoring signal change. In detailing their comprehensive protocol for managing high-risk spine patients at Northwestern, Halpin et al 23 highlighted the intraoperative features necessary for appropriate management, especially the need for communication among teams and keeping up with blood loss. This management protocol, however, is meant to encompass the full scope of care of high-risk spine patients from their preoperative evaluation through their postoperative course.…”

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confidence: 99%

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The design, development, and implementation of a checklist for intraoperative neuromonitoring changes

Ziewacz¹,

Berven

Mummaneni³

et al. 2012

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Object The purpose of this study was to provide an evidence-based algorithm for the design, development, and implementation of a new checklist for the response to an intraoperative neuromonitoring alert during spine surgery. Methods The aviation and surgical literature was surveyed for evidence of successful checklist design, development, and implementation. The limitations of checklists and the barriers to their implementation were reviewed. Based on this review, an algorithm for neurosurgical checklist creation and implementation was developed. Using this algorithm, a multidisciplinary team surveyed the literature for the best practices for how to respond to an intraoperative neuromonitoring alert. All stakeholders then reviewed the evidence and came to consensus regarding items for inclusion in the checklist. Results A checklist for responding to an intraoperative neuromonitoring alert was devised. It highlights the specific roles of the anesthesiologist, surgeon, and neuromonitoring personnel and encourages communication between teams. It focuses on the items critical for identifying and correcting reversible causes of neuromonitoring alerts. Following initial design, the checklist draft was reviewed and amended with stakeholder input. The checklist was then evaluated in a small-scale trial and revised based on usability and feasibility. Conclusions The authors have developed an evidence-based algorithm for the design, development, and implementation of checklists in neurosurgery and have used this algorithm to devise a checklist for responding to intraoperative neuromonitoring alerts in spine surgery.

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“…Complex spine surgery, defined as a surgical procedure requiring six or more levels of vertebral fusion, is typically used to correct adult lumbar scoliosis. This type of procedure is a high-risk undertaking and is often quite morbid in nature [10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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

Buchlak

Yanamadala

Lévêque

et al. 2016

Curr Rev Musculoskelet Med

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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.

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Standardizing Care for High-Risk Patients in Spine Surgery

Abstract: Standardizing preoperative risk assessment may lead to better outcomes after major spine operations. A high-risk spine protocol may help patients by having dedicated physicians in multiple specialties focusing on all aspects of a patients care in the pre-, intra-, and postoperative phases.

Cited by 82 publications

References 56 publications

The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

The Implementation and Efficacy of the Northwestern High Risk Spine Protocol

The design, development, and implementation of a checklist for intraoperative neuromonitoring changes

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

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