Gabriel N Friedman1, Joshua A Benton2, Murray Echt2, Rafael De la Garza Ramos2, John H Shin1, Jean-Valery C E Coumans1, Andrew I Gitkind3, Reza Yassari2, Jean-Christophe Leveque4, Rajiv K Sethi5, Vijay Yanamadala6. 1. Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 2. Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. 3. Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. 4. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA. 5. Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA. 6. Center for Surgical Optimization, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Spinal Disorders Study Group, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA; Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA. Electronic address: yanamadala.vijay@gmail.com.
Abstract
BACKGROUND CONTEXT: Complex spine surgery carries a high complication rate that can produce suboptimal outcomes for patients undergoing these extensive operations. However, multidisciplinary pathways introduced at multiple institutions have demonstrated a promising potential toward reducing the burden of complications in patients being treated for spinal deformities. To date, there has been no effort to systematically collate the multidisciplinary approaches in use at various institutions. PURPOSE: The present study aims to determine effective multidisciplinary strategies for reducing the complication rate in complex spine surgery by analyzing existing institutional multidisciplinary approaches and delineating common themes across multiple practice settings. STUDY DESIGN: Systematic review. METHODS: We followed guidelines established under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The studies reported on data from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Cochrane. We included articles that described either approaches to, or results from, the implementation of multidisciplinary paradigms during the preoperative, perioperative, and postoperative phases of care for patients undergoing complex spine surgery. We excluded studies that only targeted one complication unless such an approach was in coordination with more extensive multidisciplinary planning at the same institution. RESULTS: A total of 406 unique articles were identified. Following an initial determination based on title and abstract, 22 articles met criteria for full-text review, and 10 met the inclusion criteria to be included in the review. Key aspects of multidisciplinary approaches to complex spine surgery included extensive preoperative workup and interdisciplinary conferencing, intraoperative communication and monitoring, and postoperative floor management and discharge planning. These strategies produced decreases in surgical duration and complication rates. CONCLUSIONS: This study represents the first to systematically analyze multidisciplinary approaches to reduce complications in complex spine surgery. This review provides a roadmap toward reducing the elevated complication rate for patients undergoing complex spine surgery.
BACKGROUND CONTEXT: Complex spine surgery carries a high complication rate that can produce suboptimal outcomes for patients undergoing these extensive operations. However, multidisciplinary pathways introduced at multiple institutions have demonstrated a promising potential toward reducing the burden of complications in patients being treated for spinal deformities. To date, there has been no effort to systematically collate the multidisciplinary approaches in use at various institutions. PURPOSE: The present study aims to determine effective multidisciplinary strategies for reducing the complication rate in complex spine surgery by analyzing existing institutional multidisciplinary approaches and delineating common themes across multiple practice settings. STUDY DESIGN: Systematic review. METHODS: We followed guidelines established under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The studies reported on data from PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Cochrane. We included articles that described either approaches to, or results from, the implementation of multidisciplinary paradigms during the preoperative, perioperative, and postoperative phases of care for patients undergoing complex spine surgery. We excluded studies that only targeted one complication unless such an approach was in coordination with more extensive multidisciplinary planning at the same institution. RESULTS: A total of 406 unique articles were identified. Following an initial determination based on title and abstract, 22 articles met criteria for full-text review, and 10 met the inclusion criteria to be included in the review. Key aspects of multidisciplinary approaches to complex spine surgery included extensive preoperative workup and interdisciplinary conferencing, intraoperative communication and monitoring, and postoperative floor management and discharge planning. These strategies produced decreases in surgical duration and complication rates. CONCLUSIONS: This study represents the first to systematically analyze multidisciplinary approaches to reduce complications in complex spine surgery. This review provides a roadmap toward reducing the elevated complication rate for patients undergoing complex spine surgery.
Authors: Ishan Naidu; Jessica Ryvlin; Devin Videlefsky; Jiyue Qin; Wenzhu B Mowrey; Jong H Choi; Chloe Citron; James Gary; Joshua A Benton; Brandon T Weiss; Michael Longo; Nabil N Matmati; Rafael De la Garza Ramos; Jonathan Krystal; Murray Echt; Yaroslav Gelfand; Phillip Cezayirli; Neeky Yassari; Benjamin Wang; Erida Castro-Rivas; Mark Headlam; Adaobi Udemba; Lavinia Williams; Andrew I Gitkind; Reza Yassari; Vijay Yanamadala Journal: J Clin Med Date: 2022-05-05 Impact factor: 4.964