175 A Patient Prioritization Tool for Non-elective Spine Surgeries: Improving Patient Outcomes and Reducing Adverse Events in a Level-1 Trauma Center

Abstract

INTRODUCTION: The ability to provide comprehensive care at a level 1 trauma center has become challenging, especially considering the impact of COVID on healthcare. These resource-intensive challenges have been exacerbated by provider burnout and a shortage of healthcare providers. In a high-volume tertiary care center, these factors have led to delayed access to care, and potentially an increased incidence of adverse outcomes for non-elective surgical patients. As health systems learn to adapt to these challenges, developing protocols or tools to prioritize patients is paramount for sustainable healthcare systems. METHODS: A database review of all non-elective surgeries at a single level 1 trauma center. RESULTS: A total of 2,088 surgeries were analyzed and 764 (36%) of surgeries were delayed. There was an increase in the prevalence of delays following the start of COVID-19 (33% to 37%), especially amongst the patients who did not require emergent surgery (<12 hours) (51% vs 38%, p < 0.0001). The average time delay to surgery increased from 54.5 hours to 168 hours peaking at 312 hours mid-pandemic. The prevalence of any complication for all patients was 13.3%, including 1.2% mortality rate, 8.1% readmission rate within 90 days, 0.6% infection rate and prolonged LOS (10.2 vs 9.2 days). Amongst the patients with surgical delays, there was a statistically higher mortality rate (3% vs 1%, p-value < 0.05), complication rate (34.7% vs 13.1%, p < 0.0001) and readmission rate (23% vs 8%, p < 0.0001). CONCLUSIONS: An increase in delay for non-elective spine surgery led to increased hospital resource utilization, higher complication and readmission rates, and higher mortality rates in a level-1 trauma center.