247. Multidisciplinary conference for complex surgery leads to improved quality and safety

Abstract

<h3>BACKGROUND CONTEXT</h3> Complex surgery for adult spinal deformity has high rates of complications, reoperations, and readmissions. Multidisciplinary conferences have been shown to improve patient outcomes in many medical specialties but are not currently widespread in spine surgery. Preoperative discussions of high-risk operative spine patients at a multidisciplinary conference may decrease rates of these adverse outcomes through appropriate patient selection and surgical plan optimization. With this goal, we implemented a high-risk case conference involving orthopedic and neurosurgery spine, anesthesia, intraoperative monitoring neurology, and neurological intensive care on 2/19/2019. <h3>PURPOSE</h3> Examine rates of intraoperative and postoperative complications, readmissions, and reoperations in high-risk spine patients before and after the implementation of a multidisciplinary high risk case conference. <h3>STUDY DESIGN/SETTING</h3> Single institution retrospective review. <h3>PATIENT SAMPLE</h3> This study included 236 surgical adult spinal deformity patients who met one of the following criteria for presentation to the conference: 8+ levels fused, osteoporosis with 4+ levels fused, 3-column osteotomy, anterior revision of the same lumbar level, or severe myelopathy, scoliosis (>75˚), or kyphosis (>75˚) with planned significant correction. <h3>OUTCOME MEASURES</h3> Intra- and postoperative complications and 30- and 90-day readmissions and reoperations. <h3>METHODS</h3> Retrospective review was performed for the patient sample. Patients were categorized as Before Conference (BC): surgery before 2/19/2019 or After Conference (AC): surgery after 2/19/2019. Statistical analysis included independent samples t-tests and chi-squared analysis with significance set at p<0.05. <h3>RESULTS</h3> A total of 236 patients were included (67 AC, 169 BC). AC was older than BC (60.2 vs 54.4, p=0.033), but had similar BMI (27.0 vs 29.0, p=0.061), CCI (3.27 vs 2.92 p=0.266), and ASA classification (2.5 vs 2.6, p=0.911). Surgical characteristics, including levels fused (10.4 vs 10.7, p=0.558), levels decompressed (1.5 vs 1.2, p=0.375), 3-column osteotomies (11.9% vs 18.3%, p=0.232), anterior column release (13.4% vs 12.4%, p=0.834), and revision cases (50.7% vs 52.4%, p=0.821) were similar between AC and BC. AC had lower EBL (1174.0 vs 1850.2, p=0.001), fewer intraoperative complications (17.9% vs 33.7%, p=0.016) and fewer delayed extubations (6.0% vs 22.5%, p=0.003). Length of stay was similar between groups (7.0 vs 8.1, 0.245). AC had a lower incidence of DVT/PE (0% vs 5.9%, p=0.042), but a higher rate of hypotension requiring vasopressor therapy (19.4% vs 4.7%, p=0.002). Other postoperative complications were similar between groups. AC had lower rates of reoperation at 30 (0% vs 8.9%, p=0.012) and 90 days (1.5% vs 12.4%, p=0.009). AC trended toward lower readmission rates at 30 (4.5% vs 10.7%, p=0.133) and 90 days (7.5% vs 15.4%, p=0.104). <h3>CONCLUSIONS</h3> Following implementation of a multidisciplinary high-risk case conference, 30- and 90-day reoperation rates and intraoperative complications decreased in the high-risk spine surgery population. Postoperative thromboembolic events decreased. Hypotensive events requiring vasopressors increased, but this did not result in a longer length of stay or greater readmissions. These results demonstrate the important role of this conference in improving quality and safety for high-risk spine patients. Multidisciplinary conferences should be considered to minimize complications and optimize outcomes in complex spine surgery. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.