TY - JOUR
T1 - The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery
T2 - A Systematic Review, Part 2
AU - ISSG
AU - Sethi, Rajiv K.
AU - Burton, Douglas C.
AU - Wright, Anna K.
AU - Lenke, Larry G.
AU - Cerpa, Meghan
AU - Kelly, Michael P.
AU - Daniels, Alan H.
AU - Ames, Christopher P.
AU - Klineberg, Eric O.
AU - Mundis, Gregory M.
AU - Bess, Shay
AU - Hart, Robert A.
N1 - Publisher Copyright:
© 2019 Scoliosis Research Society
PY - 2019/9
Y1 - 2019/9
N2 - Study Design: Structured literature review. Objectives: To review the current literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. Summary of Background Data: Application of lean methodology to health care involves standardization of work flow. Successful implementation of LEAN management can lead to dramatic reduction in variability and waste. Frailty, hemoglobin A1c (HbA1c) concentration, vitamin D level, mental health status, intraoperative fluid management (IFM), and tranexamic acid (TXA) administration may be modified to reduce complications after ASD surgery. Methods: Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, Ovid, and Google Scholar databases were used to identify abstracts and citations for this review. Each topic was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). From 373 initial citations with abstract, 134 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 43 included studies. Results: We found fair evidence supporting an association between preoperative mental health disorders, frailty, vitamin D deficiency, and higher HbA1c levels and increased complications. Conversely, we found good evidence supporting an association between the use of intraoperative TXA and an optimized intraoperative fluid management and decreased complications. Conclusion: Gaps in the existing literature limit our ability to evaluate if all of the patient and surgical factors selected for this review are associated with increased or decreased complications and reoperations in ASD surgery. However, for both intraoperative TXA usage and optimized intraoperative fluid management that were supported by good evidence, developing Standard Work Protocols may optimize care. Level of Evidence: Level II.
AB - Study Design: Structured literature review. Objectives: To review the current literature for potentially modifiable patient and surgical factors that could be incorporated into a Standard Work protocol to decrease complications in adult spinal deformity (ASD) surgery. Summary of Background Data: Application of lean methodology to health care involves standardization of work flow. Successful implementation of LEAN management can lead to dramatic reduction in variability and waste. Frailty, hemoglobin A1c (HbA1c) concentration, vitamin D level, mental health status, intraoperative fluid management (IFM), and tranexamic acid (TXA) administration may be modified to reduce complications after ASD surgery. Methods: Cochrane Central Register of Controlled Trials, MEDLINE/PubMed, Ovid, and Google Scholar databases were used to identify abstracts and citations for this review. Each topic was developed into an appropriate clinical question that included the patient population, surgical intervention, a comparison group, and outcomes measure (PICO question). From 373 initial citations with abstract, 134 articles underwent full-text review. The best available evidence for clinical questions regarding the influence of these factors was provided by 43 included studies. Results: We found fair evidence supporting an association between preoperative mental health disorders, frailty, vitamin D deficiency, and higher HbA1c levels and increased complications. Conversely, we found good evidence supporting an association between the use of intraoperative TXA and an optimized intraoperative fluid management and decreased complications. Conclusion: Gaps in the existing literature limit our ability to evaluate if all of the patient and surgical factors selected for this review are associated with increased or decreased complications and reoperations in ASD surgery. However, for both intraoperative TXA usage and optimized intraoperative fluid management that were supported by good evidence, developing Standard Work Protocols may optimize care. Level of Evidence: Level II.
KW - Adult spinal deformity surgery
KW - Lean
UR - http://www.scopus.com/inward/record.url?scp=85064314883&partnerID=8YFLogxK
U2 - 10.1016/j.jspd.2019.03.001
DO - 10.1016/j.jspd.2019.03.001
M3 - Article
C2 - 31495467
AN - SCOPUS:85064314883
SN - 2212-134X
VL - 7
SP - 684
EP - 695
JO - Spine deformity
JF - Spine deformity
IS - 5
ER -