The Seattle Spine Team Approach to Adult Deformity Surgery: A Systems-Based Approach to Perioperative Care and...

Area of Science:

• Spine Surgery
• Surgical Outcomes
• Patient Safety

Background:

• High complication rates in adult spinal deformity surgery necessitate improved safety protocols.
• Existing approaches require systemic enhancements for better patient outcomes.
• A multidisciplinary team approach was investigated to address these challenges.

Purpose of the Study:

• To evaluate the impact of a novel, integrated team approach on complication rates in adult spinal deformity surgery.
• To characterize the specific effects of a dual-attending surgeon strategy, preoperative screening, and intraoperative coagulopathy management.

Main Methods:

• Retrospective review of consecutive cases before and after intervention implementation.
• Group A (n=40) received standard care; Group B (n=124) underwent the 3-pronged approach: dual-attending surgeons, multidisciplinary preoperative screening, and intraoperative coagulopathy protocol.
• Patient demographics and surgical complexity (9-15 levels fused) were comparable between groups.

Main Results:

• The intervention group (Group B) demonstrated significantly lower overall complication rates (16% vs. 52%, p < .001).
• Specific reductions were observed in 90-day return to OR rates (0.8% vs. 12.5%, p < .001), wound infections (1.6% vs. 7.5%), DVT/PE (3.2% vs. 10%), and UTIs (9.7% vs. 32.5%, p < .001).
• Postoperative neurological complication rates were also lower in Group B (0.5% vs. 2.5%).

Conclusions:

• A comprehensive team approach, integrating dual-attending surgeons, preoperative screening, and intraoperative protocols, significantly reduces perioperative complications.
• This integrated strategy enhances patient safety in complex spinal reconstructions for adult spinal deformity.
• The findings support the widespread adoption of such systematic protocols to improve surgical outcomes.