Two Spine Surgeons Safer Than One

A team approach in complex spinal reconstructive surgery reduces rates of major complications by two-thirds, according to a new study.

Researchers at Virginia Mason Hospital (Seattle, WA, USA) have developed a standardized protocol before, during, and after complex reconstructive surgery for spinal deformity in adult patients, which stresses three main features; two surgeons—a neurosurgeon and an orthopedic surgeon with specialized spine training—in the operating room, a live preoperative screening conference, and monitoring and management of bleeding during the operation. The researchers then reviewed 164 consecutive patients; 40 before and 124 after the new three-pronged approach was implemented.

The results showed that after implementation, patients were three times less likely to develop major complications, with the areas of improvement including significant reductions in rates of wound infection requiring debridement, deep vein thrombosis (DVT), pulmonary embolism (PE), lower rates of postoperative neurological complications, and lower rates of urinary tract infection requiring antibiotics. Patients were also significantly less likely to have to return to the operating room within 90 days after the surgery. The study describing the new protocol was published in the March 2014 issue of Spine Deformity.

“Reconstructive surgery for adults with spine deformities like scoliosis and kyphosis is being done increasingly often,” said lead author Rajiv Sethi, MD, director of spinal deformity and complex reconstruction at Virginia Mason. “But this kind of surgery tends to be long and difficult, and it is among the most dangerous and complication-ridden of all operations. And often the outcomes and complications are unacceptable, including some patients losing more blood than they started with.”

The preoperative screening conference includes operative surgeons, an internist, a physical medicine and rehabilitation physician, the nurses who coordinate a class for complex spine patients, and at least two members of the anesthesiology team dedicated to complex spine surgery. Together, they identify and treat health and medication issues that, undetected, might otherwise derail an operation at the last minute. Planning well in advance, they discuss and decide whether proposed surgery is appropriate for each patient.

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