The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery: A Systematic Review, Part 2

ISSG

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalSpine Deformity
DOIs
StatePublished - Jan 1 2019

Fingerprint

Tranexamic Acid
Health Status
Mental Health
Hemoglobins
Aptitude
Vitamin D Deficiency
Workflow
Reoperation
PubMed
Mental Disorders
Vitamin D
MEDLINE
Outcome Assessment (Health Care)
Databases
Delivery of Health Care
Population

Keywords

  • Adult spinal deformity surgery
  • Lean

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

@article{9c10bda8b9ed46e09229e791ed42ef19,
title = "The Role of Potentially Modifiable Factors in a Standard Work Protocol to Decrease Complications in Adult Spinal Deformity Surgery: A Systematic Review, Part 2",
abstract = "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.",
keywords = "Adult spinal deformity surgery, Lean",
author = "ISSG and Sethi, {Rajiv K.} and Burton, {Douglas C.} and Wright, {Anna K.} and Lenke, {Larry G.} and Meghan Cerpa and Kelly, {Michael P.} and Daniels, {Alan H.} and Ames, {Christopher P.} and Klineberg, {Eric Otto} and Mundis, {Gregory M.} and Shay Bess and Hart, {Robert A.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jspd.2019.03.001",
language = "English (US)",
journal = "Spine Deformity",
issn = "2212-134X",
publisher = "Elsevier BV",

}

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 Otto

AU - Mundis, Gregory M.

AU - Bess, Shay

AU - Hart, Robert A.

PY - 2019/1/1

Y1 - 2019/1/1

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

UR - http://www.scopus.com/inward/citedby.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

JO - Spine Deformity

JF - Spine Deformity

SN - 2212-134X

ER -