Disaster Scenarios in Spine Surgery: A Survey Analysis

Area of Science:

• Spine Surgery
• Surgical Education
• Patient Safety

Background:

• Major intraoperative events are infrequently part of formal surgical training due to rarity and limited evidence.
• Effective management of surgical complications is crucial for patient outcomes.
• Identifying areas for improved decision-making in adverse event management is essential for spine surgeons.

Purpose of the Study:

• To determine current consensus and identify discrepancies among spine surgeons regarding the management of adverse intraoperative events.
• To assess spine surgeons' preferred reactions to various intraoperative scenarios.

Main Methods:

• A survey was administered to 28 spine surgeons and fellows, presenting five hypothetical intraoperative scenarios.
• Scenarios included: neuro-monitoring signal loss, cardiac arrest, hypoxia, vertebral artery injury, and hypotension.
• Respondents' preferred actions were recorded and ranked by frequency.

Main Results:

• Loss of neuro-monitoring signals showed the most uniform response among participants.
• Cardiac compromise scenarios exhibited the most heterogeneous responses.
• While some "best" responses had consensus, concerning "distractor" options were also selected.

Conclusions:

• Significant heterogeneity in responses to critical intraoperative events indicates a need for enhanced and targeted education for spine surgeons.
• The study's vignettes can guide the development of simulation-based training for future spine surgeons.
• Improved training in managing unexpected intraoperative events can enhance decision-making and patient safety.