Quality, Safety, and Value of Innovating Classic Operative Techniques in Scoliosis Surgery: Intraoperative Traction and Navigated Sequential Drilling

• Published in: Spine deformity Vol. 7; no. 4; p. 588
• Main Authors: Bourget-Murray, Jonathan, Brown, Garielle E, Peiro-Garcia, Alejandro, Earp, Madalene A, Parsons, David L, Ferri-de-Barros, Fábio
• Format: Journal Article
• Language: English
• Published: England 01.07.2019
• Subjects: Cost-analysis; Pediatrics; Quality improvement; Adolescent idiopathic scoliosis; Posterior spinal instrumentation and fusion
• ISSN: 2212-1358

Retrospective cohort study. This study aims to measure and describe the clinical and financial implications of the systematic implementation of intraoperative skull-femoral traction (IOSFT) and navigated sequential drilling (NSD) for posterior spinal instrumentation and fusion (PSIF) in adolescent idiopathic scoliosis (AIS) at our institution. PSIF has been the standard surgical treatment for AIS. This retrospective single-center quality improvement study describes the perioperative outcomes and impact on health resource utilization following the systematic application of two classic surgical strategies modified using current technology: IOSFT and NSD. We reviewed the medical records of 125 patients who underwent a single-stage PSIF for AIS. We identified three cohorts based on surgical strategies used intraoperatively. Traditional techniques (n = 28), IOSFT (n = 45), and IOSFT plus NSD (n = 52). The primary outcome measures were operative time, prevalence of cases requiring extended operating room time, need for blood transfusion, length of hospital stay, and cost per surgery. Secondary outcomes included implant density, degree of spine deformity correction, and perioperative complications. All primary outcome measures improved significantly (p < .001). Median operating time decreased by 59%. Use of late operating room hours fell from 89% to 0% and transfusion rates from 64% to 1.9%. Length of hospital stay decreased from 6 to 4 days. Comprehensive cost per case decreased by 24%. Together, IOSFT and NSD improved the quality, safety, and value of care. These surgical strategies were performed without increased perioperative complications, while reducing cost per case by 24%. The data presented may have significant implications in health resource utilization for AIS surgery. Level III.