The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal...

Area of Science:

• Orthopedic Surgery
• Spinal Deformity
• Surgical Outcomes

Background:

• Adult spinal deformity (ASD) surgery has a high complication rate.
• Standard Work protocols, based on Lean Methodology, aim to reduce errors and improve efficiency.
• Several patient and surgical factors may influence ASD surgery complications.

Purpose of the Study:

• To evaluate the literature for modifiable factors impacting ASD surgery complications.
• To identify evidence supporting the inclusion of these factors in a Standard Work protocol.

Main Methods:

• A structured literature review was conducted using PICO questions.
• Searched databases for studies on preoperative hemoglobin, bone density, BMI, albumin/prealbumin, smoking status, and realignment.
• Analyzed 93 studies providing evidence for the selected factors.

Main Results:

• Fair evidence links low hemoglobin, low albumin/prealbumin, and high BMI to increased complications.
• Fair evidence connects smoking to increased reoperations, with conflicting data on complications.
• No evidence was found for age-appropriate realignment influencing complications.

Conclusions:

• Preoperative hemoglobin, bone density, BMI, albumin/prealbumin, and smoking status are modifiable risk factors in ASD surgery.
• These factors should be integrated into Standard Work protocols for patient optimization.
• Standardized patient evaluation and optimization can potentially decrease surgical complications.