Ajay Patel1, Samuel Stegelmann2, Josue D Ordaz1, Virendra Desai1, Francisco Angulo-Parker3, Sara Cartwright3, Gloria Fritsch1, Philip Flory1, Ann Coon3, Sarah K Johnson4, Sarah Delima5, Jeffrey S Raskin6. 1. Department of Neurological Surgery, Division of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Rm #1601C, Indianapolis, IN, 46202, USA. 2. Indiana University School of Medicine Indianapolis, Indianapolis, IN, USA. 3. Section of Physical Medicine & Rehabilitation, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA. 4. Section of Physical Therapy, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA. 5. Section of Pediatric Neurology, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA. 6. Department of Neurological Surgery, Division of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital Drive, Rm #1601C, Indianapolis, IN, 46202, USA. jraskin@iuhealth.org.
Abstract
PURPOSE: Intrathecal baclofen (ITB) has been an effective therapy since the 1980s, with widely reported revision, infection, and complication rates. Publications targeting surgical workflow have resulted in decreased infection and revision rates, but a standard workflow for the entire pathway has not been described. To present, define, and test standard work tools for patients receiving ITB to promote uniformity and standard of care in the field. METHODS: A multidisciplinary approach from the movement disorder program of a tertiary care center defined all steps comprising the ITB pathway, and then developed standard work tools to decrease variability with respect to preoperative workup, day of surgery protocol, post-operative care, and also evaluation and treatment with respect to pump infection or malfunction. RESULTS: Defined steps used at specific points of ITB pathway are presented with a single institution's outcome using the protocol from July 2017 to November 2020. A total of 60 procedures were performed. The overall complication rate was 14.5% at 6 months. Complications included an infection rate of 3.6% at 6 months, wound revision rate of 1.8% at 6 months, CSF leak rate of 1.7% at 6 months, and a 30-day readmission rate related to initial surgery of 6.7%. CONCLUSIONS: Workflow efficiency and optimization for ITB patients can be used to obtain lower complication rates compared to historical cohorts in literature. A single-center, retrospective review highlights this.
PURPOSE: Intrathecal baclofen (ITB) has been an effective therapy since the 1980s, with widely reported revision, infection, and complication rates. Publications targeting surgical workflow have resulted in decreased infection and revision rates, but a standard workflow for the entire pathway has not been described. To present, define, and test standard work tools for patients receiving ITB to promote uniformity and standard of care in the field. METHODS: A multidisciplinary approach from the movement disorder program of a tertiary care center defined all steps comprising the ITB pathway, and then developed standard work tools to decrease variability with respect to preoperative workup, day of surgery protocol, post-operative care, and also evaluation and treatment with respect to pump infection or malfunction. RESULTS: Defined steps used at specific points of ITB pathway are presented with a single institution's outcome using the protocol from July 2017 to November 2020. A total of 60 procedures were performed. The overall complication rate was 14.5% at 6 months. Complications included an infection rate of 3.6% at 6 months, wound revision rate of 1.8% at 6 months, CSF leak rate of 1.7% at 6 months, and a 30-day readmission rate related to initial surgery of 6.7%. CONCLUSIONS: Workflow efficiency and optimization for ITBpatients can be used to obtain lower complication rates compared to historical cohorts in literature. A single-center, retrospective review highlights this.
Authors: A Leland Albright; Yasser Awaad; Michael Muhonen; William R Boydston; Richard Gilmartin; Linda E Krach; Michael Turner; Kathryn A Zidek; Ed Wright; Dale Swift; Karen Bloom Journal: J Neurosurg Date: 2004-08 Impact factor: 5.115