Douglas C Burton1, Rajiv K Sethi2, Anna K Wright3, Alan H Daniels4, Christopher P Ames5, Daniel B Reid4, Eric O Klineberg6, Robert Harper6, Gregory M Mundis7, Randall J Hlubek8, Shay Bess9, Robert A Hart10, Michael P Kelly11, Lawrence G Lenke12. 1. Department of Orthopedic Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA. Electronic address: DBURTON@kumc.edu. 2. Neuroscience Institute, Virginia Mason Hospital, 1100 Ninth Avenue, Seattle, WA 98101, USA; Department of Health Services, University of Washington, NE Pacific Street, Seattle, WA 98195, USA. 3. Neuroscience Institute, Virginia Mason Hospital, 1100 Ninth Avenue, Seattle, WA 98101, USA. 4. Department of Orthopedics, Brown University, 222 Richmond Street, Providence, RI 02912, USA. 5. Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, San Francisco, CA 94131, USA. 6. Department of Orthopedic Surgery, University of California, 1 Shields Avenue, Davis, CA 95616, USA. 7. San Diego Spine Foundation, 6190 Cornerstone Ct. E, Suite 212, San Diego, CA 92121, USA. 8. Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA. 9. Denver International Spine Center, Presbyterian St. Luke's Medical Center, Rocky Mountain Hospital for Children, 2055 High Street, Suite 130, Denver, CO 80205, USA. 10. Swedish Neuroscience Institute, 550 17th Avenue, Suite 540, Seattle, WA 98122, USA. 11. Department of Orthopaedics, Washington University St. Louis, 1 Brookings Dr., St. Louis, MO 63130, USA. 12. Department of Orthopedic Surgery, Columbia University, Och Spine Hospital, 5141 Broadway, New York, NY 10034, USA.
Abstract
STUDY DESIGN: Structured Literature Review. OBJECTIVES: We sought to evaluate the peer-reviewed literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Lean Methodology uses Standard Work to improve efficiency and decrease waste and error. ASD is known to have a high surgical complication rate. Several patient and surgical potentially modifiable factors have been suggested to affect complications, including preoperative hemoglobin, bone density, body mass index (BMI), age-appropriate realignment, preoperative albumin/prealbumin, and smoking status. We sought to evaluate the literature for evidence supporting these factors to include in a Standard Work protocol to decrease complications. METHODS: Each of these six factors was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). A comprehensive literature search was then performed. The authors reviewed abstracts and analyzed data from included studies. From 456 initial citations with abstract, 173 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 93 included studies. RESULTS: We found fair evidence supporting a low preoperative hemoglobin level associated with increased transfusion rates and decreased BMD and increased BMI associated with increased complication rates. Fair evidence supported low albumin/prealbumin associated with increased complications. There was fair evidence associating smoking exposure to increased reoperations, but conflicting evidence associating it with increased complications. There was no evidence in the literature evaluating age-appropriate realignment and complications. CONCLUSION: Preoperative hemoglobin, bone density, body mass index, preoperative albumin/prealbumin, and smoking status all are potentially modifiable risk factors that are associated with increased complications in the adult spine surgery population. Developing a Standard Work Protocol for patient evaluation and optimization should include these factors. LEVEL OF EVIDENCE: Level II.
STUDY DESIGN: Structured Literature Review. OBJECTIVES: We sought to evaluate the peer-reviewed literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA: Lean Methodology uses Standard Work to improve efficiency and decrease waste and error. ASD is known to have a high surgical complication rate. Several patient and surgical potentially modifiable factors have been suggested to affect complications, including preoperative hemoglobin, bone density, body mass index (BMI), age-appropriate realignment, preoperative albumin/prealbumin, and smoking status. We sought to evaluate the literature for evidence supporting these factors to include in a Standard Work protocol to decrease complications. METHODS: Each of these six factors was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). A comprehensive literature search was then performed. The authors reviewed abstracts and analyzed data from included studies. From 456 initial citations with abstract, 173 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 93 included studies. RESULTS: We found fair evidence supporting a low preoperative hemoglobin level associated with increased transfusion rates and decreased BMD and increased BMI associated with increased complication rates. Fair evidence supported low albumin/prealbumin associated with increased complications. There was fair evidence associating smoking exposure to increased reoperations, but conflicting evidence associating it with increased complications. There was no evidence in the literature evaluating age-appropriate realignment and complications. CONCLUSION: Preoperative hemoglobin, bone density, body mass index, preoperative albumin/prealbumin, and smoking status all are potentially modifiable risk factors that are associated with increased complications in the adult spine surgery population. Developing a Standard Work Protocol for patient evaluation and optimization should include these factors. LEVEL OF EVIDENCE: Level II.
Authors: James T Bernatz; Alec E Winzenried; Kristyn J Hare; Anthony L Mikula; Seth K Williams; Neil C Binkley; Paul A Anderson Journal: J Am Acad Orthop Surg Glob Res Rev Date: 2022-03-15
Authors: Nathan J Lee; Lawrence G Lenke; Meghan Cerpa; Joseph Lombardi; Alex Ha; Paul Park; Eric Leung; Zeeshan M Sardar; Ronald A Lehman Journal: Global Spine J Date: 2020-09-03