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

Area of Science:

• Spine Surgery
• Orthopedic Surgery
• Surgical Outcomes

Background:

• Lean methodology promotes standardization to reduce variability and waste in healthcare.
• Patient factors like frailty, HbA1c, vitamin D, and mental health, along with surgical aspects like fluid management and TXA, may influence adult spinal deformity (ASD) surgery complications.

Purpose of the Study:

• To identify modifiable patient and surgical factors for a Standard Work protocol.
• To decrease complications in adult spinal deformity (ASD) surgery.

Main Methods:

• A structured literature review was conducted using multiple databases (Cochrane, PubMed, Ovid, Google Scholar).
• PICO questions guided the review, leading to full-text review of 134 articles from 373 initial citations.
• 43 studies provided evidence for the selected factors in ASD surgery.

Main Results:

• Fair evidence links preoperative mental health disorders, frailty, vitamin D deficiency, and elevated HbA1c to increased complications.
• Good evidence supports the use of intraoperative tranexamic acid (TXA) and optimized intraoperative fluid management (IFM) in reducing complications.

Conclusions:

• While literature gaps exist, intraoperative TXA and optimized IFM show strong evidence for complication reduction in ASD surgery.
• Developing Standard Work Protocols for TXA and IFM can optimize patient care and surgical outcomes.