The University of Oklahoma Inpatient Spine Protocol: optimizing surgical outcomes through standardized perioperative...

Standardized care delivery protocols have demonstrated substantial benefits across a range of surgical subspecialties, with growing evidence supporting their application to elective spinal surgery. At our institution, we have developed and implemented a comprehensive spine surgery protocol that spans both the ambulatory and inpatient phases of care. In this manuscript, we focus on our inpatient protocol, which incorporates a standardized checklist designed to reduce surgical morbidity and enhance patient outcomes. Key areas of focus include mitigation of surgical site infections, wound complications, decreasing opioid use and dependency, and accelerating functional recovery. Each intervention has been selected and is based upon evidence from the literature, clinical relevance, and feasibility, and is applied systematically across each phase of care: pre-incision, intraoperative, and postoperative phases. While the protocol is currently being piloted among high-risk patients, it is designed for future scalability and institution-wide integration. Importantly, although focused on the inpatient surgical episode, this portion of the protocol's benefits extends beyond hospitalization. By targeting the modifiable risk factors most closely associated with postoperative complications and readmissions, this protocol has the potential to reduce healthcare utilization and improve long-term outcomes. In doing so, it contributes meaningfully to the growing body of literature supporting standardized care protocols as a critical tool in delivering high-value, outcome-driven spine care.