Multidisciplinary conference for complex surgery leads to improved quality and safety

Area of Science:

• Spine Surgery
• Patient Safety
• Multidisciplinary Care

Background:

• Complex adult spinal deformity surgery has high complication and reoperation rates.
• Multidisciplinary conferences can optimize surgical plans and patient selection for high-risk cases.
• A high-risk case conference was implemented involving multiple surgical and medical specialties.

Purpose of the Study:

• To evaluate the impact of a multidisciplinary high-risk case conference on surgical outcomes.
• To assess changes in complication, reoperation, and readmission rates after conference implementation.

Main Methods:

• Retrospective review of 263 high-risk spinal surgery patients (≥18 years old).
• Patients categorized as Before Conference (BC) or After Conference (AC) based on surgery date.
• Outcome measures included intraoperative/postoperative complications, readmissions, and reoperations.

Main Results:

• The After Conference (AC) group showed significantly lower EBL, fewer intraoperative complications (including dural tears, delayed extubations), and reduced deep surgical site infections.
• AC patients had lower 30- and 90-day reoperation and readmission rates.
• AC group experienced a higher incidence of hypotension requiring vasopressors, but this did not increase length of stay or readmissions.

Conclusions:

• Implementation of a multidisciplinary high-risk case conference is associated with improved outcomes in complex spine surgery.
• The conference led to decreased reoperation, readmission, intraoperative complications, and deep surgical site infections.
• While hypotension increased, overall quality and safety for high-risk spine patients were enhanced.